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Elbasha K, Kaur J, Abdelghani M, Landt M, Alotaibi S, Abdelaziz A, Abdel-Wahab M, Toelg R, Geist V, Richardt G, Allali A. Ten-year Durability, Hemodynamic Performance, and Clinical Outcomes after Transcatheter Aortic Valve Implantation Using a Self-expanding Device. Cardiol Ther 2024:10.1007/s40119-024-00369-2. [PMID: 38734999 DOI: 10.1007/s40119-024-00369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION The expansion of transcatheter aortic valve implantation (TAVI) to low-risk and younger patients has increased the relevance of the long-term durability of transcatheter heart valves (THV). The present study aims to assess the 10-year durability, hemodynamic performance, and clinical outcomes after TAVI using the CoreValve system. METHODS An analysis from a prospective registry with predefined clinical and echocardiographic follow-up included 302 patients who underwent TAVI with the CoreValve system between 2007 and 2015. Bioprosthetic valve failure (BVF) was defined as any bioprosthetic valve dysfunction-related death, re-intervention, or severe hemodynamic valve deterioration. RESULTS At the time of TAVI, the mean age was 80.41 ± 7.01 years, and the Society of Thoracic Surgeons (STS) score was 6.13 ± 5.23%. At latest follow-up (median [IQR]: 5 [2-7] years), cumulative all-cause mortality rates at 3, 5, 7, and 10 years was 23.7%, 40%, 65.8%, and 89.8%, respectively. Mean aortic valve area and transvalvular gradient post-TAVI and at 5, 7, and 10 years were 1.94, 1.87, 1.69, and 1.98 cm2 (p = 0.236) and 8.3, 9.0, 8.2, and 10.1 mmHg (p = 0.796), respectively. Overall, 11 patients had BVF, of whom six had structural valve deterioration (SVD). The 10-year actual and actuarial freedom from BVF was 96.1% and 78.8%, and from SVD was 97.9% and 80.9%, respectively. Three patients developed significant non-SVD due to severe paravalvular leakage, and two patients were diagnosed with infective endocarditis. CONCLUSION Using an early-generation self-expanding bioprosthesis, we documented durable hemodynamic performance and low rates of BVF and SVD up to 10 years after TAVI.
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Affiliation(s)
- Karim Elbasha
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Sharkia, Egypt.
| | - Jatinderjit Kaur
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Mohammad Abdelghani
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
- Cardiology Unit, Department of Internal Medicine, Sohar Hospital, Sohar, Oman
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Martin Landt
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Sultan Alotaibi
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiac Centre, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Centre Leipzig at the University of Leipzig, Leipzig, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Volker Geist
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- University Heart Centre Lübeck, Medical Clinic II, Lübeck, Germany
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Ansari U, Brachmann J, Lewalter T, Zeymer U, Sievert H, Ledwoch J, Geist V, Hochadel M, Schneider S, Senges J, Akin I, Fastner C. LAA occlusion is effective and safe in very high-risk atrial fibrillation patients with prior stroke: results from the multicentre German LAARGE registry. Clin Res Cardiol 2024:10.1007/s00392-024-02376-8. [PMID: 38294498 DOI: 10.1007/s00392-024-02376-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Interventional left atrial appendage occlusion (LAAO) mitigates the risk of thromboembolic events in nonvalvular atrial fibrillation (AF) patients with contraindication for long-term oral anticoagulation (OAC). Patients with prior stroke have a relevantly increased risk of recurrent stroke, so the effectiveness of LAAO could be reduced in this specific very high-risk patient group. AIM This sub-study of the LAARGE registry investigates the effectiveness and safety of LAAO for secondary prevention in nonvalvular AF patients with a history of stroke. METHODS LAARGE is a prospective, non-randomised registry on the clinical reality of LAAO. The current sub-study employs data from index procedure and 1-year follow-up. Effectiveness and safety were assessed by documentation of all-cause mortality, non-fatal thromboembolism, procedure-related complications, and bleeding events. RESULTS A total of 638 patients were consecutively included from 38 hospitals in Germany and divided into two groups: 137 patients with a history of stroke (21.5%) and 501 patients without. Successful implantation was consistent between both groups (98.5% vs. 97.4%, p = NS), while peri-procedural MACCE and other complications were rare (0% vs. 0.6% and 4.4% vs. 4.0%, respectively; each p = NS). Kaplan-Meier estimate showed no significant difference in primary effectiveness outcome measure (freedom from all-cause death or non-fatal stroke) between both groups at follow-up (87.8% vs. 87.7%, p = NS). The incidence of transient ischemic attack or systemic embolism at follow-up was low (0% vs. 0.5% and 0.9% vs. 0%, respectively; each p = NS). Severe bleeding events after hospital discharge were rare (0% vs. 0.7%, p = NS). CONCLUSIONS Patients with prior stroke demonstrated similar effectiveness and safety profile for LAAO as compared to patients without prior stroke. LAAO could serve as a feasible alternative to OAC for secondary stroke prevention in this selected group of nonvalvular AF patients. CLINICALTRIALS GOV IDENTIFIER NCT02230748.
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Affiliation(s)
- Uzair Ansari
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Johannes Brachmann
- Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg Hospital, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
| | - Thorsten Lewalter
- Department of Medicine, Cardiology, and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | - Uwe Zeymer
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt am Main, Germany
| | - Jakob Ledwoch
- Isar Herz Zentrum München, ISAR Klinikum, Munich, Germany
- Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, München Klinik Neuperlach, Munich, Germany
| | - Volker Geist
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Fastner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Elbasha K, Alotaibi S, Heyer H, Mankerious N, Toelg R, Geist V, Richardt G, Allali A. Predictors of long-term adverse outcomes after successful chronic total occlusion intervention: physiology or morphology? Clin Res Cardiol 2023:10.1007/s00392-023-02279-0. [PMID: 37542021 DOI: 10.1007/s00392-023-02279-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Quantitative flow ratio (QFR) and target-vessel SYNTAX score (tvSS) are novel indices used to assess lesion physiology and morphology in percutaneous coronary intervention (PCI). Their prognostic implication after successful recanalization of coronary chronic total occlusion (CTO) is unknown. OBJECTIVES To investigate the prognostic value of QFR measured immediately after successful CTO-recanalization in predicting vessel-oriented adverse events, and to compare it with the pre-procedural morphological tvSS. METHODS QFR was measured offline after successful CTO-PCIs in a single center. We grouped the patients according to a cut-off value of post-PCI QFR (0.91). The primary outcome was target-vessel failure (TVF) at 2 years. RESULTS Among 470 CTO lesions performed during the study period, 324 were eligible for QFR analysis (258 with QFR ≥ 0.91 and 66 with QFR < 0.91). The mean age of the study population was 68.3 ± 10.7 years. The low QFR group had a lower left ventricular ejection fraction (45.8 ± 13.9% vs. 49.8 ± 12.4%, p = 0.025) and a higher rate of atrial fibrillation (19.7% vs. 11.2%, p = 0.020). The mean tvSS was 12.8 ± 4.8, and it showed no significant difference in both groups (13.6 ± 5.1 vs. 12.6 ± 4.6, p = 0.122). Patients with low post-CTO QFR had a trend to develop more TVF at 2 years (21.2% vs. 12.4%, HR 1.74; 95% CI 0.93-3.25, p = 0.086). Low post-CTO QFR failed to predict 2-year TVF (aHR 1.67; 95% CI 0.85-3.29, p = 0.136), while pre-procedural tvSS was an independent predictor for 2-year TVF (aHR 1.06; 95% CI 1.01-1.13, p = 0.030). CONCLUSION We found a limited prognostic value of immediate physiological assessment using QFR after successful CTO intervention. Pre-procedure morphological characteristics of CTO lesions using tvSS can play a role in predicting long-term adverse events.
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Affiliation(s)
- Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Sharkia, Egypt.
| | - Sultan Alotaibi
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiac Centre, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hajo Heyer
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Sharkia, Egypt
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Volker Geist
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Medical Clinic II, University Heart Centre Lübeck, Lübeck, Germany
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Kany S, Skibowski J, Müller CH, Geist V, Schmitt J, Niroomand F, Hailer B, Pleger S, Akin I, Hochadel M, Senges J, Lubos E. Association of atrial myopathy in mitral valve disease on safety outcomes in left atrial appendage closure. Clin Res Cardiol 2023; 112:824-833. [PMID: 36739561 PMCID: PMC10241670 DOI: 10.1007/s00392-022-02151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/23/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients undergoing left atrial appendage (LAA) occlusion (LAAO) are multi-morbid, including mitral valve disease (MVD) which is associated with anatomic changes of the left atrium (LA). This study aims to identify how atrial myopathy in MVD influences outcomes in LAAO. METHODS Atrial myopathy in MVD was defined as LA diameter > 45 mm (♀) and > 48 mm (♂) and existing MVD or history of surgical/interventional treatment. Patients were compared with controls from the prospective, multicentre LAArge registry of LAAO. RESULTS A total of 528 patients (52 MVD, 476 no-MVD) were included. The MVD group was significantly more likely to be older (78.2 years vs 75.9 years, p = 0.036) and female (59.6% vs 37.8%, p = 0.002). Altered LA anatomy was observed in MVD with significantly larger LA diameter (53 mm vs. 48 mm, p < 0.001) and LAA Ostia [at 135° 23.0 mm (20.5, 26.0) vs 20.0 mm (18.0, 23.0), p = 0.002]. Implant success was high with 96.2% and 97.9%, respectively, without differences in severe complications (7.7% vs 4.6%, p = 0.31). One-year mortality (17.8% vs 11.5%, p = 0.19) and a combined outcome of death, stroke, and systemic embolism (20.3% vs 12.4%, p = 0.13) were not different. Independent predictors of the combined outcome were peripheral artery disease (HR 2.41, 95% CI 1.46-3.98, p < 0.001) and chronic kidney disease (HR 3.46, 95% CI 2.02-5.93, p < 0.001) but not MVD and atrial myopathy. CONCLUSION Patients with MVD present with altered LA anatomy with increased LA and LAA diameter. However, procedural success and safety in LAAO are not compromised. One-year mortality is numerically higher in patients with MVD but driven by comorbidities.
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Affiliation(s)
- Shinwan Kany
- Division of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - Johanna Skibowski
- Division of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | | | - Volker Geist
- Division of Cardiology, Segeberger Kliniken, Bad Segeberg, Germany
| | - Jörn Schmitt
- Division of Cardiology, University Hospital Giessen, Giessen, Germany
| | - Feraydoon Niroomand
- Division of Cardiology, St. Josefskrankenhaus Heidelberg, Heidelberg, Germany
| | - Birgit Hailer
- Division of Cardiology and Angiology, Phillipusstift Essen, Essen, Germany
| | - Sven Pleger
- Division of Cardiology, University Hospital Heilberg, Heidelberg, Germany
| | - Ibrahim Akin
- Division of Cardiology, University Hospital Mannheim, Mannheim, Germany
| | | | - Jochen Senges
- Stiftung Für Herzinfarktforschung, Ludwigshafen, Germany
| | - Edith Lubos
- Division of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
- Division of Cardiology, Marienkrankenhaus Hamburg, Hamburg, Germany
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Allali A, Richardt G, Toelg R, Elbasha K, Sulimov DS, Kastrati A, Geist V, El-Mawardy M, Rheude T, Abdel-Wahab M. High-speed rotational atherectomy versus modified balloons for plaque preparation of severely calcified coronary lesions: two-year outcomes of the randomised PREPARE-CALC trial. EUROINTERVENTION 2023; 18:e1365-e1367. [PMID: 36579635 PMCID: PMC10068860 DOI: 10.4244/eij-d-22-00677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/21/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | - Volker Geist
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Tobias Rheude
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
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Fitzgerald S, Gimenez MR, Allali A, Toelg R, Sulimov DS, Geist V, Kastrati A, Thiele H, Richardt G, Abdel-Wahab M. Sex-specific Inequalities in the Treatment of Severely Calcified Coronary Lesions: A Sub-analysis of the PREPARE-CALC Trial. Interv Cardiol 2023; 18:e02. [PMID: 36891034 PMCID: PMC9987508 DOI: 10.15420/icr.2022.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/09/2022] [Indexed: 01/21/2023] Open
Abstract
Background: Coronary vessels in women may have anatomical and histological particularities. The aim of this study was to investigate sex-specific characteristics and outcomes of patients with calcified coronary arteries in the Prepare-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) trial. Methods: The Prepare-CALC trial randomised patients with severe coronary calcification to coronary lesion preparation either using modified balloons (MB; cutting or scoring) or rotational atherectomy (RA). Results: Of 200 randomised patients, 24% were women. Strategy success in general was similar between women (93.8%) and men (88.2%; p=0.27). For men, strategy success was significantly more common with an RA-based strategy than an MB-based strategy (98.7% in the RA group versus 77.3% in the MB group, p<0.001), whereas for women there was no evidence of a significant difference in strategy success between RA and MB (95.7% in the RA group versus 92% in the MB group, p>0.99, p for interaction between sex and treatment strategy=0.03). Overall, significant complications such as death, MI, stent thrombosis, bypass operation and perforations were rare and did not differ significantly by gender or treatment strategy. Plaque rupture and disrupted calcified nodules were more common in women. Conclusion: In a well-defined patient population with severely calcified coronary arteries, lesion preparation with an RA-strategy was superior to an MB-strategy in men. For women, both RA and MB strategies appear to have a similar success rate, although definitive conclusions are limited due to the small number of women in the trial.
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Affiliation(s)
- Sean Fitzgerald
- Heart Center Leipzig Leipzig, Germany.,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences Dublin, Ireland
| | | | | | - Ralph Toelg
- Heart Center, Segeberger Kliniken Bad Segeberg, Germany
| | | | - Volker Geist
- Heart Center, Segeberger Kliniken Bad Segeberg, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technical University of Munich Germany
| | | | - Gert Richardt
- Heart Center, Segeberger Kliniken Bad Segeberg, Germany
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Allali A, Toelg R, Abdel-Wahab M, Hemetsberger R, Kastrati A, Mankerious N, Traboulsi H, Elbasha K, Rheude T, Landt M, Geist V, Richardt G. Combined rotational atherectomy and cutting balloon angioplasty prior to drug-eluting stent implantation in severely calcified coronary lesions: The PREPARE-CALC-COMBO study. Catheter Cardiovasc Interv 2022; 100:979-989. [PMID: 36262074 DOI: 10.1002/ccd.30423] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/01/2022] [Revised: 09/09/2022] [Accepted: 10/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of lesion preparation using rotational atherectomy (RA) with consecutive cutting balloon angioplasty (Rota-Cut). BACKGROUND Whether the Rota-Cut combination improves stent performance in severely calcified coronary lesions is unknown. METHODS PREPARE-CALC-COMBO is a single-arm prospective trial in which 110 patients were treated with a Rota-Cut strategy before implantation of sirolimus-eluting stents and compared with patients treated with modified balloon (MB, scoring or cutting) or RA from a historical cohort (the randomized PREPARE-CALC trial). The study had two primary endpoints: in-stent acute lumen gain (ALG) by quantitative angiographic analysis and stent expansion (SE) on optical coherence tomography. RESULTS In-stent ALG was significantly higher with Rota-Cut compared to RA or MB alone (1.92 ± 0.45 mm vs. 1.74 ± 0.45 mm with MB vs. 1.70 ± 0.42 mm with RA; p = 0.001 and p < 0.001, respectively). SE was comparable between groups (75.1 ± 13.8% vs. 73.5 ± 13.3 with MB vs. 73.1 ± 12.2 with RA; p = 0.19 and p = 0.39, respectively). The Rota-Cut combination resulted in higher minimal stent area (MSA) (7.1 ± 2.2mm2 vs. 6.1 ± 1.7mm2 with MB vs. 6.2 ± 1.9mm2 with RA; p = 0.003 and p = 0.004, respectively). In-hospital death occurred in one patient. Target vessel failure at 9 months was low and comparable between groups (8.2% vs. 8% with MB vs. 6% with RA; p = 1 and p = 0.79, respectively). CONCLUSION Rota-Cut combination resulted in higher ALG and larger MSA compared with historical control of RA or MB alone, but was not associated with higher SE. Despite extensive lesion preparation, this strategy is safe, feasible, and associated with favorable clinical outcome at 9 months.
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Affiliation(s)
- Abdelhakim Allali
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany.,Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Rayyan Hemetsberger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | | | | | - Karim Elbasha
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany.,Cardiology Department, Faculty of Medicine, Zagazig university, Zagazig, Egypt
| | - Tobias Rheude
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | - Martin Landt
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Volker Geist
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
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Fitzgerald S, Allali A, Toelg R, Sulimov DS, Geist V, Kastrati A, Thiele H, Neumann FJ, Richardt G, Abdel-Wahab M. Angiographic predictors of unplanned rotational atherectomy in complex calcified coronary artery disease: a pooled analysis from the randomised ROTAXUS and PREPARE-CALC trials. EUROINTERVENTION 2022; 17:1506-1513. [PMID: 34609284 PMCID: PMC9896390 DOI: 10.4244/eij-d-21-00612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
BACKGROUND Calcified coronary lesions present therapeutic challenges for the interventional cardiologist, often requiring rotational atherectomy (RA). AIMS This study aimed to develop an angiographic scoring tool to predict the need for a priori RA. METHODS A pooled analysis of the randomised ROTAXUS and PREPARE-CALC studies was carried out, (N=220 patients, N=313 lesions), by virtue of the fact that both studies made provision for crossover to RA (from balloon dilatation or modified balloon dilatation, respectively). Logistical regression techniques were employed to assess for the presence of patient- or lesion-specific factors leading to a necessity for RA. External validation was performed though retrospective calculation of the score for 192 patients who underwent bail-out RA in a single centre. RESULTS Lesion length (odds ratio [OR] 1.02, 95% confidence interval [CI]: 1.00-1.04 per mm, p=0.04), bifurcation lesion (OR 2.60, 95% CI: 1.27-5.30, p=0.009), vessel tortuosity >45° (OR 3.49, 95% CI: 1.73-7.03, p<0.001) and severe vessel calcification (OR 11.60, 95% CI: 3.40-39.64, p<0.001) were predictive of the need for RA in multivariate analysis. Based on the regression coefficients, a scoring system was devised. The greater the score, the more likely a lesion required RA. The scoring system performed well in the external validation cohort, with 78% of patients crossing over having a score of greater than the proposed cut-off of 3. CONCLUSIONS We provide an angiographic scoring tool to support the expeditious use of time and resources, allowing assessment of the likelihood of success of a balloon-based strategy, or the necessity for RA.
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Affiliation(s)
- Sean Fitzgerald
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Ralph Toelg
- Heart Centre, Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Volker Geist
- Heart Centre, Segeberger Kliniken, Bad Segeberg, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Holger Thiele
- University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Gert Richardt
- Heart Centre, Segeberger Kliniken, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Heart Centre Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr. 39, 04289 Leipzig, Germany
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Fastner C, Brachmann J, Lewalter T, Zeymer U, Sievert H, Ledwoch J, Geist V, Hochadel M, Schneider S, Senges J, Akin I, Ansari U. Adverse events and stroke prevention by interventional left atrial appendage occlusion in patients with low CHA 2 DS 2 -VASc score-results from the multicenter German LAARGE registry. Catheter Cardiovasc Interv 2022; 99:2064-2070. [PMID: 35384249 DOI: 10.1002/ccd.30165] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Interventional left atrial appendage occlusion (LAAO) is routinely performed in patients with nonvalvular atrial fibrillation and contraindications to standard anticoagulation. AIMS We investigated its role in patients at low stroke risk, and compared the effectiveness and safety in patients with low versus high risk. METHODS LAARGE is a prospective registry depicting the clinical reality of LAAO. LAAO was conducted with different standard commercial devices, and follow-up period was 1 year. Patients with started procedure and documented CHA2 DS2 -VASc score were selected from the whole database. RESULTS A total of 638 patients from 38 centers were divided into CHA2 DS2 -VASc score ≤2, i.e., low-risk group (10.2%), and >2, i.e., high-risk group (89.8%). The latter had a pronounced cardiovascular risk profile and preceding strokes (0% vs. 23.9%; p < 0.001). Implantation success was consistently high (97.6%), frequencies of intrahospital major adverse cardiac and cerebrovascular events (0% vs. 0.5%) and other major complications (4.6% vs. 4.0%) were low (each p = not significant [NS]). Numerous moderate complications were also observed in the low-risk patients (12.3% vs. 9.4%; p = NS). Frequencies of nonfatal strokes (0% vs. 0.7%) and severe bleedings (0% vs. 0.7%) were low (each p = NS). In a specig analysis, patients at very high risk of stroke (i.e., CHA2 DS2 -VASc score >4) did not have increased rates of complications or nonfatal strokes in the first year after the procedure. CONCLUSIONS Low-risk patients had no nonfatal strokes and major bleedings within 1 year after hospital discha but had unexpectedly high rates of moderate procedural complications. The indication in these patients should be strictly defined based on an individual benefit-risk assessment.
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Affiliation(s)
- Christian Fastner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Johannes Brachmann
- REGIOMED-Kliniken, Coburg, Germany.,University of Split, School of Medicine, Split, Croatia
| | - Thorsten Lewalter
- Department of Medicine, Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | - Uwe Zeymer
- Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
| | - Jakob Ledwoch
- Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, München Klinik Neuperlach, Munich, Germany
| | - Volker Geist
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Uzair Ansari
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Zahn R, Kment H, Schofer J, Lubos E, Geist V, Eggebrecht H, Butter C, Wolf A, Schaefer U, Schumacher B, Schneider S. Interventional treatment of para-valvular leaks after prosthetic valve replacement with plug devices -first results from a prospective registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1639] [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: 11/12/2022] Open
Abstract
Abstract
Background
Interventional closure of symptomatic paravalvular leaks (PVL) after surgical or interventional valve replacement by plug implantation has emerged as an alternative to surgical correction, which is associated with high morbitity and mortality rates. To date, data on procedural efficacy and clinical outcome after transcatheter closure with plugs is sparse, especially prospective data are missing.
Methods
We analysed data from a multi-center prospective registry on interventional PVL closure with plug devices.
Results
Between 06/2012 and 04/2020 55 interventions were performed with different numbers of plugs (maximal 4) in 51 patients at 9 hospitals. Interventions were performed in 15 women and 36 men at high surgical risk for repeat surgery. 48% of procedures were performed for mitral PVLs and 52% procedures were performed for aortic PVLs. Mean age of the population treated was 69±13 years and mean log. Euro-Score I was 22.5±14.2%. Patients were treated by implantation of Amplatzer Vascular Plug III (80%) and Occlutec occluders (9%). Aortic PVLs were treated using a retrograde transfemoral access, mitral PVLs were treated using either a transseptal (25/26) or transapical access (1/26) with 3-dimensional transesophageal echocardiographic and fluoroscopic guidance. Indication for PVL closure was previous surgery (n=39), high-risk patients (n=24), heart failure (n=22), age (n=20) and hemolysis (n=12). 40 patients had NYHA class III/IV at admission. Interventional closure of PVL was completely successful in 40 procedures (73%), partially successful in 7 procedures (13%) and failed in 7 procedures (13%). NYHA class I/II after PVL closure was achieved in 75% patients. However, 8 out of 12 patients with hemolysis as indication still hemolyzed at discharge. Complications occurred in 16% of patients. In-hospital mortality rate was 4% of procedures (2/51). After hospital discharge no death occurred during 30-day follow-up.
Conclusions
In this prospective interventional PVL registry inclusion rate was lower than expected. There was an equal distribution of aortal and mitral PVLs. At least partial success could be achieved in 86% of patients, with significant functional improvement in most patients. In this high risk population hospital mortaliy was low (4%), indicating that interventional PVL treatment should be the treatment of choice, when discussed by a heart team.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Zahn
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - H Kment
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - J Schofer
- Medical Care Center Hamburg, Hamburg, Germany
| | - E Lubos
- University Heart Center Hamburg, Hamburg, Germany
| | - V Geist
- Segeberger Clinics, Bad Segeberg, Germany
| | - H Eggebrecht
- CCB am Markus Hospital, Frankfurt am Main, Germany
| | - C Butter
- Brandenburg Heart Center, Bernau bei Berlin, Germany
| | - A Wolf
- Elisabeth-Hospital, Essen, Germany
| | - U Schaefer
- University Heart Center Hamburg, Hamburg, Germany
| | | | - S Schneider
- Klinikum Ludwigshafen, Ludwigshafen, Germany
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Kleinecke C, Lewalter T, Sievert H, Geist V, Zeymer U, Mudra H, Pleger S, Hochadel M, Senges J, Brachmann J. Interventional occlusion of left atrial appendage in patients with atrial fibrillation. Gender-related outcomes in the German LAARGE Registry. J Cardiovasc Electrophysiol 2021; 32:2636-2644. [PMID: 34314065 DOI: 10.1111/jce.15189] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/01/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Gender-based differences in atrial fibrillation have been identified, but limited data exist for patients undergoing left atrial appendage occluder (LAAO) implantation. This study reports gender-related periprocedural and 1-year outcomes of the prospective, multicenter German left atrial appendage occlusion registry (LAARGE). METHODS LAARGE enrolled 641 patients who were scheduled for LAAO implantation from July 2014 to January 2016 in 38 hospitals in Germany. The data collected included demographics, clinical characteristics, details of implantation, and outcome. Efficacy and safety at 1-year follow-up were assessed by the occurrence of thrombembolic and bleeding events, as well as mortality. RESULTS Of 638 patients undergoing LAAO implantation 38.9% were female and 61.1% male. Females were older (76.4 ± 8.2 [females] vs. 75.6 ± 7.7 [males], p = .042) and had a higher stroke risk (CHA2 DS2 -VASc score: 4.9 ± 1.5 vs. 4.3 ± 1.5, p < .001). In contrast, males suffered more often from coronary artery (33.1% vs. 53.8%, p < .001) and vascular disease (18.5% vs. 31.0%, p < .001). Technical success was high and similar for both genders (98.4% vs. 97.2%, p = .33). Severe periprocedural complications (6.9% vs. 3.1%, p = .032) occurred more often in females. At 1-year follow-up the rates of all-cause stroke (0.5% vs. 1.3%, p = .65) and severe bleeding (0.0% and 1.0%, p = .29) were low and comparable between the genders. Also, one-year all-cause mortality (9.2% vs. 13.1%, p = .14) did not differ significantly. CONCLUSION LAARGE documented in this elderly patient population undergoing LAAO implantation a higher rate of severe periprocedural complications in females. At 1-year follow-up similar efficacy and safety outcomes were observed for both genders.
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Affiliation(s)
- Caroline Kleinecke
- Department of Cardiology, Klinikum Hochrhein, Waldshut-Tiengen, Germany
- Department of Cardiology, Klinikum Coburg, Coburg, Germany
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Peter Osypka Heart Center Munich, Munich, Germany
| | | | - Volker Geist
- Department of Cardiology, Klinikum Bad Segeberg, Bad Segeberg, Germany
| | - Uwe Zeymer
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany
- Institut für Herzinfarktforschung, Ludwigsburg, Germany
| | - Harald Mudra
- Department of Cardiology, Klinikum Neuperlach, Munich, Germany
| | - Sven Pleger
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jochen Senges
- Institut für Herzinfarktforschung, Ludwigsburg, Germany
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Ledwoch J, Franke J, Akin I, Geist V, Weiß C, Zeymer U, Pleger S, Hochadel M, Mudra H, Senges J, Lewalter T, Brachmann J, Sievert H. WATCHMAN versus ACP or Amulet devices for left atrial appendage occlusion: a sub-analysis of the multicentre LAARGE registry. EUROINTERVENTION 2020; 16:e942-e949. [DOI: 10.4244/eij-d-19-01027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Ledwoch J, Franke J, Akin I, Geist V, Weiss C, Zeymer U, Pleger S, Hochadel M, Mudra H, Senges J, Lewalter T, Brachmann J, Sievert H. WATCHMAN versus ACP or amulet for left atrial appendage closure. Results from the LAARGE registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2659] [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
Several left atrial appendage (LAA) closure systems are available and due to differences in device design safety and efficacy of specific occluders derived from trials cannot be simply generalized to all devices.
Purpose
The present analysis sought to assess two contemporary LAA closure devices in clinical practice.
Methods
The present work represents a non-randomized sub-analysis of the prospective, multicenter, Left-Atrium-Appendage Occluder Register - GErmany (LAARGE) registry. The WATCHMAN (group 1) and the Amplatzer Cardiac Plug (ACP) or Amulet occluder (group 2) were assessed regarding technical success and procedural safety.
Results
A total of 641 patients at 38 centers were enrolled. Of them, 278 (43%) and 340 (53%) patients received the WATCHMAN and ACP/Amulet occluder, respectively. High technical success was achieved with a slight difference between the groups (96% in group 1 vs. 99% in group 2; p=0.007). Procedural safety did not differ (98% in group 1 vs. 97% in group 2; p=0.55). Chicken wing morphology of the LAA seemed to trigger the use of the ACP/Amulet (chicken wing in 36% of the cases in group 1 vs. 55% in group 2; p<0.001). The Kaplan Meier estimated 1-year composite of death or stroke was 12.0% and 12.9%, respectively (Figure 1A). The respective rates for the composite endpoint of death, stroke or systemic embolism were 12.0% and 13.2% (Figure 1B).
Conclusions
Both the WATCHMAN and the ACP/Amulet occluder provide excellent procedural results with comparable implantation success and no differences regarding procedural safety and long-term effectiveness.
Figure 1. Composite endpoints at 1-year
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Stiftung Institut für Herzinfarktforschung (IHF)
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Affiliation(s)
- J Ledwoch
- Klinikum Neuperlach, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Munich, Germany
| | - J Franke
- CardioVascular Center Frankfurt, Frankfurt, Germany
| | - I Akin
- University Medical Centre of Mannheim, Mannheim, Germany
| | - V Geist
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - C Weiss
- Hospital Lueneburg, Lueneburg, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - S Pleger
- University Hospital of Heidelberg, Heidelberg, Germany
| | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - H Mudra
- Klinikum Neuperlach, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Munich, Germany
| | - J Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - T Lewalter
- Peter Osypka Heart Center, Munich, Germany
| | | | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
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14
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Fastner C, Brachmann J, Lewalter T, Zeymer U, Sievert H, Borggrefe M, Weiß C, Geist V, Krapivsky A, Käunicke M, Mudra H, Hochadel M, Schneider S, Senges J, Akin I. Left atrial appendage closure in patients with a reduced left ventricular ejection fraction: results from the multicenter German LAARGE registry. Clin Res Cardiol 2020; 109:1333-1341. [PMID: 32236717 PMCID: PMC7588387 DOI: 10.1007/s00392-020-01627-8] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
Abstract
Background Interventional left atrial appendage closure (LAAC) effectively prevents thromboembolic events in atrial fibrillation patients. Impaired left ventricular ejection fraction (LVEF) increases not only the thromboembolic risk but also the complication rates of cardiac interventions. The LAAC procedure’s benefit in patients with an impaired LVEF, therefore, has yet to be investigated. Methods LAARGE is a prospective, non-randomized registry depicting the clinical reality of LAAC in Germany. Procedure was conducted with different standard commercial devices, and follow-up period was one year. In the sense of an as-treated analysis, patients with started procedure and documented LVEF were selected from the whole database. Results 619 patients from 37 centers were categorized into one of three groups: LVEF > 55% (56%), 36–55% (36%), and ≤ 35% (8%). Prevalence of cardiovascular comorbidity increased with LVEF reduction (p < 0.001 for trend). CHA2DS2-VASc score was 4.3, 4.8, and 5.1 (p < 0.001), and HAS-BLED score was 3.7, 4.1, and 4.2 (p < 0.001). Implantation success was consistently high (97.9%), rates of intra-hospital MACCE (0.5%), and other major complications (4.2%) were low (each p = NS). Kaplan–Meier estimation showed a decrease in survival free of stroke with LVEF reduction during one-year follow-up (89.3 vs. 87.0 vs. 79.8%; p = 0.067), a trend which was no longer evident after adjustment for relevant confounding factors. Rates of non-fatal strokes (0.4 vs. 1.1 vs. 0%) and severe bleedings (0.7 vs. 0.0 vs. 3.1%) were consistently low across all groups (each p = NS). Conclusions LVEF reduction neither influenced the procedural success nor the effectiveness and safety of stroke prevention by LAAC. Trial Registration ClinicalTrials.gov Identifier: NCT02230748 Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01627-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Fastner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,European Center for AngioScience (ECAS), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Johannes Brachmann
- Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg Hospital, Coburg, Germany
| | - Thorsten Lewalter
- Department of Medicine, Cardiology, and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | - Uwe Zeymer
- Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,European Center for AngioScience (ECAS), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Christian Weiß
- Department of Cardiology, Klinikum Lüneburg, Lüneburg, Germany
| | - Volker Geist
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Alexander Krapivsky
- Department of Cardiology, Evangelisches Krankenhaus, Mülheim (Ruhr), Germany
| | - Matthias Käunicke
- Department of Cardiology, University of Witten/Herdecke, Katholisches Klinikum Essen, Essen, Germany
| | - Harald Mudra
- Department of Cardiology, Klinikum Neuperlach, Munich, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. .,European Center for AngioScience (ECAS), Mannheim, Germany. .,DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
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Brachmann J, Lewalter T, Akin I, Sievert H, Geist V, Zeymer U, Erkapic D, Mudra H, Pleger S, Hochadel M, Senges J. Interventional occlusion of left atrial appendage in patients with atrial fibrillation. Acute and long-term outcome of occluder implantation in the LAARGE Registry. J Interv Card Electrophysiol 2019; 58:273-280. [PMID: 31707534 DOI: 10.1007/s10840-019-00635-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Left atrial appendage occluder (LAAO) implantation is an alternative method for stroke prevention in atrial fibrillation (AF) patients who are not eligible for long-term oral anticoagulation. The present paper describes the acute and 1-year follow-up outcome data of the prospective, multicenter German left atrial appendage occlusion registry (LAARGE). METHODS LAARGE enrolled 641 patients who were scheduled for LAAO implantation. The data collected included demographics, clinical characteristics, procedure indication, details of implantation, and outcome; patients were followed at 1-year post-implant. Efficacy and safety during follow-up are assessed by the occurrence of thrombembolic and bleeding events, respectively. RESULTS A total of 641 consecutive patients (mean age: 75.9 ± 8.0) were enrolled from July 2014 to January 2016 in 38 hospitals in Germany. Patient demographics represent a critically-ill population with a calculated mean CHA2DS2-VASc score and HASBLED score of 4.5 and 3.9, respectively, with bleeding events as the main indication for LAAO implantation (79.4%). One-year all-cause mortality post-procedure was 11.5% with a non-fatal stroke/TIA rate of 1.3% (8 patients) and a rate of major bleeding of 1.6% (10 patients). The anticoagulation regimen after 1 year consisted of oral anticoagulation in 5.5% of patients and an antiplatelet therapy (APT) rate of 84.1% (majority single APT with ASS (74.5%), dual APT in 6.7%). CONCLUSIONS LAARGE, a prospective multicenter real-world and all-comer registry, is unique in its concept, as it is non-manufacturer sponsored and includes all commercially available devices. LAAO implantation is mainly performed in elderly, critically-ill patients with a history of bleeding. LAARGE demonstrates a favorable outcome at 1-year follow-up in terms of stroke/TIA (1.3%) and major bleeding (1.6%) while using a single APT in the vast majority of patients.
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Affiliation(s)
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Peter Osypka Heart Center Munich, Hospital for Internal Medicine Munich South, Am Isarkanal 36, 81379, Munich, Germany.
| | - Ibrahim Akin
- Department of Cardiology, University Hospital Mannheim, Mannheim, Germany
| | - Horst Sievert
- Department of Cardiology, Katharinenhospital Frankfurt, Frankfurt, Germany
| | - Volker Geist
- Department of Cardiology, Klinkum Bad Segeberg, Bad Segeberg, Germany
| | - Uwe Zeymer
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany.,Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Damir Erkapic
- Department of Cardiology, University Hospital Giessen, Giessen, Germany
| | - Harald Mudra
- Department of Cardiology, Klinikum Neuperlach, Munich, Germany
| | - Sven Pleger
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jochen Senges
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
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16
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Fastner C, Brachmann J, Lewalter T, Zeymer U, Sievert H, Borggrefe M, Weiss C, Geist V, Krapivsky A, Kaeunicke M, Mudra H, Hochadel M, Schneider S, Senges J, Akin I. P3727Left atrial appendage closure in patients with a reduced left ventricular ejection fraction: results from the prospective multicenter German LAARGE registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0581] [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 and purpose
Atrial fibrillation (AF) patients with increased thromboembolic risk and contraindications for standard oral anticoagulation (OAC) can profit from an interventional left atrial appendage closure (LAAC). While impaired left ventricular ejection fraction (LVEF) is associated with an increased thromboembolic risk in AF patients, cardiac interventions are often associated with an increase in complications in this patient population, and, therefore, the LAAC procedure's success and benefit has yet to be investigated in this subgroup.
Methods
This prospective, observational LAAC registry included 622 patients with documented LVEF from 37 German centers between April 2014 and January 2016. Patients were categorized into one of three groups: LVEF >55% (preserved; p), LVEF 35–55% (mid-range; mr) and LVEF <35% (reduced; r). Procedure was conducted in a standard fashion, and baseline characteristics, imaging as well as procedural data, intra-hospital and one-year follow-up outcome were registered for each group.
Results
55.3% of patients had a pLVEF, 38.7% a mrLVEF and 5.9% a rLVEF. Patients with rLVEF were more often affected by coronary artery disease (p<0.001 for trend), and had an elevated CHA2DS2-VASc (4.3±1.5 vs. 4.8±1.5 vs. 5.3±1.6; p<0.001) and HAS-BLED score (3.7±1.1 vs. 4.1±1.2 vs. 4.3±0.9; p<0.001). Percentage of prior cerebrovascular events and major bleedings was comparable at baseline (each p=n.s.). Procedural success was high (97.9%), while rates of intra-hospital MACCE (0.5%) and other major complications (4.2%) were low, with no significant difference between the groups (each p=n.s.). MACCE during follow-up was more frequent in rLVEF patients (11.0 vs. 11.3 vs. 27.8%; p=0.013), which was mainly driven by myocardial infarctions and all-cause deaths in this high risk collective. Likewise, Kaplan-Meier estimation showed a lower overall survival in this group (89.7 vs. 89.3 vs. 74.6%; p<0.01). On the contrary, rates of stroke were extremely low across all groups and statistically similar (0.3 vs. 1.0 vs. 0%; p=n.s.). This was 93.4, 82.7 and 100.0% less in comparison to the estimated risk calculated from the CHA2DS2-VASc score
Conclusions
The LVEF had no influence on the procedural success as well as the intra-hospital complications after LAAC. Annual rate of stroke was low across all groups, and risk reduction was substantial especially in this high risk collective, as compared to the estimated risk.
Acknowledgement/Funding
Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
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Affiliation(s)
- C Fastner
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - J Brachmann
- Hospital Coburg, Department of Cardiology, Angiology and Pneumology, Second Medical Clinic, Coburg, Germany
| | - T Lewalter
- Hospital Munich-Thalkirchen, Department of Medicine - Cardiology and Intensive Care, Munich, Germany
| | - U Zeymer
- Heart Center Ludwigshafen, Department of Cardiology, Ludwigshafen, Germany
| | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - M Borggrefe
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - C Weiss
- Hospital Lueneburg, Department of Cardiology, Lueneburg, Germany
| | - V Geist
- Heart Center Bad Segeberg, Department of Cardiology, Bad Segeberg, Germany
| | - A Krapivsky
- Evangelisches Krankenhaus, Department of Cardiology, Muelheim (Ruhr), Germany
| | - M Kaeunicke
- University of Witten/Herdecke, Katholisches Klinikum Essen, Department of Cardiology, Essen, Germany
| | - H Mudra
- Klinikum Neuperlach, Department of Cardiology, Munich, Germany
| | - M Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - S Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - I Akin
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
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17
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Allali A, Abdel-Wahab M, Traboulsi H, Hemetsberger R, Byrne R, Geist V, El-Mawardy M, Sulimov D, Neumann FJ, Toelg R, Richardt G. TCT-244 Impact of Different Methods of Lesion Preparation on Side Branches in Calcified Coronary Bifurcations: A Subanalysis of the Randomized PREPARE-CALC Trial. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Abdel-Wahab M, Allali A, Byrne R, Geist V, El-Mawardy M, Sulimov D, Neumann FJ, Toelg R, Richardt G. TCT-26 Predictors of Bailout Rotational Atherectomy in Patients With Complex Calcified Coronary Artery Disease: A Pooled Analysis From the Randomized ROTAXUS and PREPARE-CALC Trials. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fastner C, Nienaber CA, Park JW, Brachmann J, Zeymer U, Goedde M, Sievert H, Geist V, Lewalter T, Krapivsky A, Käunicke M, Maier J, Özdemir B, Hochadel M, Schneider S, Senges J, Akin I. Impact of left atrial appendage morphology on indication and procedural outcome after interventional occlusion: results from the prospective multicentre German LAARGE registry. EUROINTERVENTION 2019; 14:151-157. [PMID: 29508766 DOI: 10.4244/eij-d-17-00866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/23/2022]
Abstract
AIMS Interventional left atrial appendage closure (LAAC) is an emerging alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) in concomitance with a contraindication for standard OAC. This sub-analysis of the LAARGE registry aimed to investigate differences between different LAA morphologies in a real-world setting. METHODS AND RESULTS This prospective, multicentre, observational registry included 562 patients from 37 centres with ineligibility for long-term OAC between April 2014 and January 2016. Baseline characteristics, indications, procedural data and complications were registered according to each LAA morphology (i.e., chicken wing, cauliflower, windsock, cactus and atypical morphologies). Implantation success was high across the four typical anatomies (≥97.5%, p=n.s.); only atypical anatomies exhibited a lower success rate (94%). The cactus-shaped LAA was linked to a trend indicating a shorter fluoroscopy time, while the atypical LAA was linked to a significantly prolonged fluoroscopy time (p=0.089 and p=0.025 versus the overall mean, respectively). Periprocedural and intra-hospital complications were generally rare, with no differences among the different morphologies (p=n.s.). CONCLUSIONS Procedural success as well as the complication rates of LAAC were not different among the four typical LAA morphologies. A lower implantation success rate was only obvious in patients with atypical LAA morphologies.
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Affiliation(s)
- Christian Fastner
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, University of Heidelberg, Mannheim, Germany
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20
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Abdel-Wahab M, Toelg R, Byrne RA, Geist V, El-Mawardy M, Allali A, Rheude T, Robinson DR, Abdelghani M, Sulimov DS, Kastrati A, Richardt G. High-Speed Rotational Atherectomy Versus Modified Balloons Prior to Drug-Eluting Stent Implantation in Severely Calcified Coronary Lesions. Circ Cardiovasc Interv 2018; 11:e007415. [DOI: 10.1161/circinterventions.118.007415] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [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] [Indexed: 12/15/2022]
Affiliation(s)
- Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
- Department of Cardiology, Heart Center Leipzig, Leipzig University Hospital, Germany (M.A.-W., D.S.S.)
| | - Ralph Toelg
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Robert A. Byrne
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (R.A.B., T.R., A.K.)
- German Center for Cardiovascular Research, partner site Munich Heart Alliance, Germany (R.A.B., A.K.)
| | - Volker Geist
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Mohamed El-Mawardy
- Department of Cardiology, Vivantes Wenckebach Hospital, Berlin, Germany (M.E.-M.)
| | - Abdelhakim Allali
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Tobias Rheude
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (R.A.B., T.R., A.K.)
| | - Derek R. Robinson
- Department of Mathematics, University of Sussex, Brighton, United Kingdom (D.R.R.)
| | - Mohammad Abdelghani
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Dmitriy S. Sulimov
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
- Department of Cardiology, Heart Center Leipzig, Leipzig University Hospital, Germany (M.A.-W., D.S.S.)
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (R.A.B., T.R., A.K.)
- German Center for Cardiovascular Research, partner site Munich Heart Alliance, Germany (R.A.B., A.K.)
| | - Gert Richardt
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
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21
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Lacava J, Geist V, Ortiz D. Impact of High Cost Anticancer Drugs´ Indications Throughout Time in Noncurative Advanced (Stage IV) Cancer Patients With Solid Tumors. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.33200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Most high cost anticancer drugs (HCAD) are indicated in noncurative advanced (stage IV) cancer patients (NCP) for palliative reasons with variable impacts on quality of life and survival. HCAD challenge health care systems because of their high prices specially in nonhigh income countries. Aim: To evaluate the proportional impact (HDCA indications/overall survival) in NCP throughout years. To analyze causes of HDCA discontinuation. To calculate time elapsed from end of HCDA treatment to end of life (ETEL index). Methods: We reviewed charts of 268 NCP treated in a Patagonian cancer institution between 2009 to 2017 with an HCDA (either alone or in combinations) according to standard of care. Mean age was 58 y (26-84), sex (m/f) 126/142, primary tumor: GI 106 (40%), GU 27 (10%), GYN 20 (7%), BR 58 (22%), LG 43 (16%), others 14 (5%). 29 different HCAD were indicated in 402 treatments (small targets therapies 35%, Moabs 60%, others 5%): 1st line 268 (100%), 2nd line 89 (33%), 3rd line 34 (13%), thereafter 11 (4%). Results: Median OS for the entire population was 26 m (1-120), while it was: GI 20 m, GU 28 m, GYN 27 m, BR 47 m, LG 18 m, Others 21 m. Proportion of OS with HCAD indications: 50% (1-100) in the whole population, while it was: GI 49% (25-100), GU 62% (5-100), GYN 39% (6-93), BR 50% (3-100), LU 45% (6-93), others 61% (25-100). HDAC indications increased over time: 26% (2009-11), 33% (2012-14), 40% (2015-17), with a more than 2% of new NCP increment per year. Additionally proportion (HCAD/OS) was: 43% (2009-11), 47% (2012-14), 52% (2015-17). Median time of HCAD according to line of therapy was: 1st line 6 m, 2nd line 4 m, 3rd line 6 m, 4th+ lines 4.5 m. Causes of discontinuation of HCAD were: disease progression in 87% of cases and 13% for toxicity/others. Median ETEL index (days) was 80 d (1-340). Conclusion: 1) HCAD are indicated during a significant proportion of life (50%) in stage IV NCP with many solid tumors. 2) Its use is increasing over years with a rate of 2% of NCP per year and for more proportion of time. 3) A great number of HCAD treatments are discontinued due to failure reasons, while it is expected more than 10% of adverse events causes. 4) ETEL index is proposed as a measurement indicator of GCP. 5) Impact of HCAD treatments is a major issue in health care policies.
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Zeymer U, Brachmann J, Lewalter T, Akin I, Sievert H, Mudra H, Geist V, Ekapic D, Pfleger S, Hochadel M, Senges J. P2897Impact of age >75 years on one-year events in patients with atrial fibrillation and left atrial appendage occluder implantation. Results of the prospective LAARGE Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- U Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | | | - T Lewalter
- Peter Osypka Herzzentrum, Munich, Germany
| | - I Akin
- University Medical Centre of Mannheim, Mannheim, Germany
| | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - H Mudra
- Klinikum Neuperlach, Munich, Germany
| | - V Geist
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - D Ekapic
- Justus-Liebig University of Giessen, Giessen, Germany
| | - S Pfleger
- University Hospital of Heidelberg, Heidelberg, Germany
| | - M Hochadel
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | - J Senges
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
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23
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Landmesser U, Schmidt B, Nielsen-Kudsk JE, Lam SCC, Park JW, Tarantini G, Cruz-Gonzalez I, Geist V, Della Bella P, Colombo A, Zeus T, Omran H, Piorkowski C, Lund J, Tondo C, Hildick-Smith D. Left atrial appendage occlusion with the AMPLATZER Amulet device: periprocedural and early clinical/echocardiographic data from a global prospective observational study. EUROINTERVENTION 2018. [PMID: 28649053 DOI: 10.4244/eij-d-17-00493] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [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: 12/15/2022]
Abstract
AIMS The global, prospective AMPLATZER Amulet observational study documents real-world periprocedural, transoesophageal echocardiographic (TEE) and clinical outcomes from left atrial appendage occlusion (LAAO) using the AMPLATZER Amulet device. The aim of this report is to describe the periprocedural and early clinical/TEE results from this study. METHODS AND RESULTS This multicentre prospective real-world registry included 1,088 patients (75±8.5 years, 64.5% male, CHA2DS2-VASc: 4.2±1.6, HAS-BLED: 3.3±1.1) with non-valvular atrial fibrillation; 82.8% of patients were considered to have an absolute or relative contraindication to long-term anticoagulation and 72.4% had had a previous major bleeding. Periprocedural results, clinical outcomes up to the first three months and the available TEE results from the first scheduled follow-up (one to three months post implant) are reported. Successful device implantation was achieved in 99.0% of patients. During the procedure and index hospitalisation, major adverse events occurred in 3.2% of patients. Patients were discharged on a single antiplatelet agent (23.0%), dual antiplatelets (54.3%) or an oral anticoagulant (18.9%). TEE follow-up 67±23 days post procedure in 673 patients showed adequate (<3 mm jet) occlusion of the appendage in 98.2% of patients and device thrombus in 10 patients (1.5%), as evaluated by core laboratory analysis. CONCLUSIONS This large real-world prospective registry of catheter-based LAAO using the AMPLATZER Amulet device reports a high implant success rate and a low periprocedural complication rate in a population with a high risk of stroke and bleeding. Transoesophageal echo data confirm good closure rates during follow-up and low rates of device-associated thrombus.
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Affiliation(s)
- Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin (CBF); Berlin Institute of Health (BIH); German Center of Cardiovascular Research (DZHK), Berlin, Germany
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Steiner S, Willfort-Ehringer A, Sievert H, Geist V, Lichtenberg M, Del Giudice C, Sauguet A, Diaz-Cartelle J, Marx C, Ströbel A, Schult I, Scheinert D. 12-Month Results From the First-in-Human Randomized Study of the Ranger Paclitaxel-Coated Balloon for Femoropopliteal Treatment. JACC Cardiovasc Interv 2018; 11:934-941. [DOI: 10.1016/j.jcin.2018.01.276] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/15/2018] [Accepted: 01/30/2018] [Indexed: 10/17/2022]
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Bausback Y, Willfort-Ehringer A, Sievert H, Geist V, Lichtenberg M, Del Giudice C, Sauguet A, Diaz-Cartelle J, Marx C, Ströbel A, Schult I, Scheinert D. Six-Month Results From the Initial Randomized Study of the Ranger Paclitaxel-Coated Balloon in the Femoropopliteal Segment. J Endovasc Ther 2017; 24:459-467. [DOI: 10.1177/1526602817710770] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Germany
- Anglia Ruskin University, Chelmsford, UK
| | | | | | | | | | | | - Claudia Marx
- CERES GmbH Evaluation & Research, Lörrach, Germany
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Allali A, Abdel-Wahab M, Sulimov DS, Jose J, Geist V, Kassner G, Richardt G, Toelg R. Comparison of Bailout and Planned Rotational Atherectomy for Heavily Calcified Coronary Lesions: A Single-Center Experience. J Interv Cardiol 2016; 30:124-133. [DOI: 10.1111/joic.12361] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Abdelhakim Allali
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
| | - Mohamed Abdel-Wahab
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
| | - Dmitriy S. Sulimov
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
| | - John Jose
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
| | - Volker Geist
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
| | - Guido Kassner
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
| | - Gert Richardt
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
| | - Ralph Toelg
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
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Schäfer U, Maisano F, Butter C, Franzen O, Baldus S, Hausleiter J, Ussia GP, Sievert H, Geist V, Widder JD, Moccetti T, Schillinger W. Impact of Preprocedural Left Ventricular Ejection Fraction on 1-Year Outcomes After MitraClip Implantation (from the ACCESS-EU Phase I, a Prospective, Multicenter, Nonrandomized Postapproval Study of the MitraClip Therapy in Europe). Am J Cardiol 2016; 118:873-880. [PMID: 27575279 DOI: 10.1016/j.amjcard.2016.06.036] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 03/01/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/28/2022]
Abstract
This report describes the 12-month outcomes of the a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe (ACCESS-EU postapproval study of MitraClip therapy) with respect to preprocedural left ventricular ejection fraction (LVEF). Transcatheter deployment of the MitraClip device may be considered for patients who are not suitable for conventional surgery. A total of 567 patients with significant mitral regurgitation (MR) underwent MitraClip therapy. Of those, 393 had functional MR (FMR) and were subdivided by preprocedural LVEF (A: 10% to 20%, B: >20% to 30%, C: >30% to 40%, D: >40%). Procedural safety and efficacy and treatment outcomes including MR grade, New York Heart Association (NYHA) functional class, 6-minute walk test, and the Minnesota Living with Heart Failure Questionnaire were analyzed at baseline, 30 days, and 12 months. Baseline mean logistic EuroSCORE was 25 ± 19; 87% of patients were in NYHA classes III or IV (A: 96%, B: 83%, C: 90%, D: 86%). There was no incidence of death or stroke intraprocedurally. Eleven patients died within 30 days with no differences among subgroups. Kaplan-Meier survival at 12 months was 81.8% (A: 71%, B: 79%, C: 87%, D: 86%). There was a significant improvement in MR severity at 30 days and 12 months (p <0.0001). At 12 months, all subgroups experienced similar improvements in NYHA class, 6-minute walk test, and Minnesota Living with Heart Failure Questionnaire. This real-world registry reports promising results of MitraClip therapy in patients with FMR. In conclusion, the low rates of hospital mortality and adverse events in patients with FMR-even in patients with severely reduced LVEF-provide additional evidence of substantial benefits after MitraClip implantation.
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Affiliation(s)
- Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Centre, Hamburg, Germany.
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Christian Butter
- Department of Cardiology, Heart Centre Brandenburg, Bernau, Germany
| | - Olaf Franzen
- Department of Cardiology, Klinik im Park, Zürich, Switzerland
| | - Stephan Baldus
- Department of Cardiology, University Heart Centre, Cologne, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Gian Paolo Ussia
- Department of Cardiology, University of Rome "Tor Vergata", Rome, Italy
| | | | - Volker Geist
- Department of Cardiology, Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany
| | - Julian Daniel Widder
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Tiziano Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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Allali A, El-Mawardy M, Schwarz B, Sato T, Geist V, Toelg R, Richardt G, Abdel-Wahab M. Incidence, feasibility and outcome of percutaneous coronary intervention after transcatheter aortic valve implantation with a self-expanding prosthesis. Results from a single center experience. Cardiovascular Revascularization Medicine 2016; 17:391-8. [DOI: 10.1016/j.carrev.2016.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/30/2016] [Accepted: 05/06/2016] [Indexed: 11/30/2022]
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Gafoor S, Sievert H, Maisano F, Baldus S, Schaefer U, Hausleiter J, Butter C, Ussia GP, Geist V, Widder JD, Moccetti T, Schillinger W, Franzen O. Gender in the ACCESS-EU registry: a prospective, multicentre, non-randomised post-market approval study of MitraClip® therapy in Europe. EUROINTERVENTION 2016; 12:e257-64. [DOI: 10.4244/eijv12i2a40] [Citation(s) in RCA: 11] [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] [Indexed: 11/23/2022]
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30
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Kebernik J, Jose J, Abdel-Wahab M, Stöcker B, Geist V, Richardt G. Safety and Efficacy of Left Atrial Appendage Closure with the Amplatzer Cardiac Plug in Very High Stroke and Bleeding Risk Patients with Non-Valvular Atrial Fibrillation. Cardiol Ther 2015; 4:167-77. [PMID: 26563411 PMCID: PMC4675748 DOI: 10.1007/s40119-015-0053-z] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Indexed: 01/05/2023] Open
Abstract
Introduction Limited data exist on the outcomes after left atrial appendage closure (LAAC) with the Amplatzer™ Cardiac Plug (ACP; St. Jude Medical, Minneapolis, MN, USA) in patients with atrial fibrillation (AF) with very high stroke and bleeding risks, the subset expected to benefit most from this procedure. The objective of this study was to report clinical outcomes after LAAC with the ACP device in a very high stroke and bleeding risk cohort of patients with non-valvular AF and contraindications to oral anticoagulation (OAC). Methods LAAC using the ACP device was performed in 96 patients with AF who had median CHA2DS2-VASc and HAS-BLED scores of 5 and 3, respectively. Post-procedure, patients received dual antiplatelet therapy for 6 months. A transesophageal echocardiography (TEE) was scheduled at 6 months. Results Procedural success was 100%. Procedural-related complications occurred in 7.3% (pericardial effusion, 4.2%; thromboembolic events, 2.1%; device embolization, 1.0%). Additional thromboembolic events occurred in three patients during follow-up (92.7% follow-up). After 93.4 patient-years of follow-up, the annual rates of thromboembolic and major bleeding events were 3.2% and 1.1%, respectively. In those with TEE follow-up (70%), complete LAAC with no leaks was observed. Thrombus formation on the device was noted on TEE in two patients. Conclusion LAAC using the ACP device was associated with an acceptable low rate of embolic and bleeding events after a median follow-up of 9 months in a cohort of patients with AF who were amongst the highest stroke and bleeding risks reported so far in LAAC trials. Electronic supplementary material The online version of this article (doi:10.1007/s40119-015-0053-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Kebernik
- Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany.
| | - John Jose
- Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Björn Stöcker
- Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Volker Geist
- Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
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de Waha S, Allali A, Büttner HJ, Toelg R, Geist V, Neumann FJ, Khattab AA, Richardt G, Abdel-Wahab M. Rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: Two-year clinical outcome of the randomized ROTAXUS trial. Catheter Cardiovasc Interv 2015; 87:691-700. [PMID: 26525804 DOI: 10.1002/ccd.26290] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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: 06/03/2015] [Revised: 07/29/2015] [Accepted: 10/03/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND In the randomized ROTAXUS trial, routine lesion preparation of complex calcified coronary lesions using rotational atherectomy (RA) prior to paclitaxel-eluting stent implantation did not reduce the primary endpoint of angiographic late lumen loss at 9 months compared to stenting without RA. So far, no long-term data of prospective head-to-head comparisons between both treatment strategies have been reported. METHODS AND RESULTS ROTAXUS randomly assigned patients with complex calcified coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120). The primary endpoint of the current analysis was the occurrence of major adverse cardiac events (MACE) at 2-year follow-up defined as the composite of death, myocardial infarction, and target vessel revascularization (TVR). At 2 years, MACE occurred in 32 patients in the RA group and 37 patients in the standard therapy group (29.4% vs. 34.3%, P = 0.47). The rates of death (8.3% vs. 7.4%, P = 1.00), myocardial infarction (8.3% vs. 6.5%, P = 0.80), target lesion revascularization (TLR, 13.8% vs. 16.7%, P = 0.58), and TVR (19.3% vs. 22.2%, P = 0.62) were similar in both groups. CONCLUSION Despite high rates of initial angiographic success, nearly one third of patients enrolled in ROTAXUS experienced MACE within 2-year follow-up, with no differences between patients treated with or without RA.
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Affiliation(s)
- Suzanne de Waha
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Heinz-Joachim Büttner
- Department of Cardiology, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ralph Toelg
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Volker Geist
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ahmed A Khattab
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Gert Richardt
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
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Sulimov DS, Abdel-Wahab M, Toelg R, Kassner G, Geist V, Richardt G. High-speed rotational atherectomy of the left main coronary artery: a single-center experience in 50 high-risk patients. Cardiovascular Revascularization Medicine 2015; 16:284-9. [DOI: 10.1016/j.carrev.2015.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/04/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
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Akin I, Khattab AA, Büttner HJ, Toelg R, Geist V, Neumann FJ, Richardt G, Abdel-Wahab M. Comparison of bivalirudin and heparin in patients undergoing rotational atherectomy: a subanalysis of the randomised ROTAXUS trial. EUROINTERVENTION 2014; 10:458-65. [DOI: 10.4244/eijv10i4a79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Schulz S, Richardt G, Laugwitz KL, Morath T, Neudecker J, Hoppmann P, Mehran R, Gershlick AH, Tolg R, Anette Fiedler K, Abdel-Wahab M, Kufner S, Schneider S, Schunkert H, Ibrahim T, Mehilli J, Kastrati A, Kastrati A, Mehilli J, Richardt G, Mehran R, Gershlick A, Mehilli J, Burgdorf C, Byrne RA, Cassese S, Fusaro M, Hausleiter J, Hengstenberg C, Joner M, Kasel M, Kastrati A, Massberg S, Ott I, Pache J, Schunkert H, Seyfarth M, Sibbing D, Tiroch K, Laugwitz KL, Ibrahim T, Hoppmann P, Schneider S, Bradaric C, Richardt G, Abdel-Wahab M, Geist V, Schwarz B, Sulimov D, Tolg R, Schulz S, Schomig G, von Merzljak B, Luckmann J, Ruf J, Morath T, Holle H, Paul H, Vogel J, Hoesl K, Rifatov N, Pastor I, Maimer-Rodrigues F, Schulz M, Neudecker J, Mayer K, Hofmann F, Mann J, Hauschke D, Schmitt C, Poci D, Barthel P, Ndrepepa G, Keta D, Byrne RA, Kufner S, Piniek S, Hurt S, Kastrati S, Anette Fiedler K. Prasugrel plus bivalirudin vs. clopidogrel plus heparin in patients with ST-segment elevation myocardial infarction. Eur Heart J 2014; 35:2285-94. [DOI: 10.1093/eurheartj/ehu182] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [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
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El-Mawardy M, Wübken-Kleinfeld N, Schwarz B, Gordian K, Stöcker B, Sier H, Toelg R, Geist V, Kraatz EG, Richardt G, Abdel-Wahab M. Transcatheter aortic valve implantation in patients with severely reduced left ventricular systolic function: a single-center experience. Clin Res Cardiol 2014; 103:621-30. [DOI: 10.1007/s00392-014-0691-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/18/2014] [Indexed: 11/28/2022]
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Werner N, Mudra H, Blacha U, Von Flotow P, Janicke I, Leschke M, Geist V, Hochadel M, Langhoff R, Zahn R. Carotid artery stenting in clinical practice: first results of the multidisciplinary GECAS registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p377] [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
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Merten C, Beurich HW, Zachow D, Mostafa AE, Geist V, Toelg R, Richardt G, Abdel-Wahab M. Aortic Regurgitation and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2013; 6:476-83. [DOI: 10.1161/circinterventions.112.000115] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Constanze Merten
- From the Heart Center (C.M., H.-W.B., V.G., R.T., G.R., M.A.-W.), and Radiology Department (D.Z.), Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany; and Cardiology Department, Ain Shams University, Cairo, Egypt (A.E.M.)
| | - Hans-Wilko Beurich
- From the Heart Center (C.M., H.-W.B., V.G., R.T., G.R., M.A.-W.), and Radiology Department (D.Z.), Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany; and Cardiology Department, Ain Shams University, Cairo, Egypt (A.E.M.)
| | - Dirk Zachow
- From the Heart Center (C.M., H.-W.B., V.G., R.T., G.R., M.A.-W.), and Radiology Department (D.Z.), Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany; and Cardiology Department, Ain Shams University, Cairo, Egypt (A.E.M.)
| | - Ahmad E. Mostafa
- From the Heart Center (C.M., H.-W.B., V.G., R.T., G.R., M.A.-W.), and Radiology Department (D.Z.), Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany; and Cardiology Department, Ain Shams University, Cairo, Egypt (A.E.M.)
| | - Volker Geist
- From the Heart Center (C.M., H.-W.B., V.G., R.T., G.R., M.A.-W.), and Radiology Department (D.Z.), Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany; and Cardiology Department, Ain Shams University, Cairo, Egypt (A.E.M.)
| | - Ralph Toelg
- From the Heart Center (C.M., H.-W.B., V.G., R.T., G.R., M.A.-W.), and Radiology Department (D.Z.), Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany; and Cardiology Department, Ain Shams University, Cairo, Egypt (A.E.M.)
| | - Gert Richardt
- From the Heart Center (C.M., H.-W.B., V.G., R.T., G.R., M.A.-W.), and Radiology Department (D.Z.), Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany; and Cardiology Department, Ain Shams University, Cairo, Egypt (A.E.M.)
| | - Mohamed Abdel-Wahab
- From the Heart Center (C.M., H.-W.B., V.G., R.T., G.R., M.A.-W.), and Radiology Department (D.Z.), Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany; and Cardiology Department, Ain Shams University, Cairo, Egypt (A.E.M.)
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Seivani Y, Abdel-Wahab M, Geist V, Richardt G, Sulimov DS, El-Mawardy M, Toelg R, Akin I. Long-term safety and efficacy of dual therapy with oral anticoagulation and clopidogrel in patients with atrial fibrillation treated with drug-eluting stents. Clin Res Cardiol 2013; 102:799-806. [DOI: 10.1007/s00392-013-0592-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/10/2013] [Indexed: 11/29/2022]
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Abdel-Wahab M, Richardt G, Joachim Büttner H, Toelg R, Geist V, Meinertz T, Schofer J, King L, Neumann FJ, Khattab AA. High-Speed Rotational Atherectomy Before Paclitaxel-Eluting Stent Implantation in Complex Calcified Coronary Lesions. JACC Cardiovasc Interv 2013; 6:10-9. [DOI: 10.1016/j.jcin.2012.07.017] [Citation(s) in RCA: 298] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 07/04/2012] [Indexed: 12/13/2022]
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Merten C, Beurich HW, Zachow D, Mostafa AE, Gordian K, Toelg R, Geist V, Abdel-Wahab M, Richardt GH. Temporal changes in left ventricular function and paravalvular aortic regurgitation after transcatheter aortic valve implantation: a cardiac magnetic resonance imaging study. J Cardiovasc Magn Reson 2012. [PMCID: PMC3305580 DOI: 10.1186/1532-429x-14-s1-p94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Abdel-Wahab M, Sulimov DS, Kassner G, Geist V, Toelg R, Richardt G. Longitudinal deformation of contemporary coronary stents: an integrated analysis of clinical experience and observations from the bench. J Interv Cardiol 2012; 25:576-85. [PMID: 23017115 DOI: 10.1111/j.1540-8183.2012.00765.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To report clinical experience with longitudinal stent deformation (LSD) and observations from the bench. BACKGROUND LSD was recently reported with thin-strut coronary stents. Whether it is related to a particular stent or constitutes a class-effect remains debatable. METHODS After 2 cases of LSD were reported, information was sent to operators to warn of this event and identify possible cases. All cases were reviewed to ensure LSD had occurred. Simultaneously, bench testing was conducted to identify the susceptibility of stents to longitudinal compression and whether LSD detection is influenced by fluoroscopic stent visibility. RESULTS Between July 2010 and November 2011, 2,705 coronary interventions were performed with 4,588 stents (Promus Element = 41.6%, Xience Prime = 24.4%). Six patients with LSD were identified, all with Promus Element (0.31%). Wire bias was a predisposing factor in 4 cases. All patients were treated with postdilatation and/or additional stenting. No adverse events occurred (mean 5.8 months). In bench testing, LSD occured in all examined stents, but at different levels of applied force (weight). Most shortening at 50 g was observed with Promus Element (38.9%), as was the best visibility of LSD on x-ray images. With postdilatation all stents showed some re-elongation. CONCLUSION In our practice LSD was a rare observation only seen with the Promus Element stent. When subjected to longitudinal compression in a bench test all contemporary stents can be compressed. Compression of Promus Element occurs at a lower force, but it is the only stent where deformations are detected with x ray. Postdilatation can partially improve LSD.
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Affiliation(s)
- Mohamed Abdel-Wahab
- Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany.
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Abdel-Wahab M, Baev R, Dieker P, Kassner G, Khattab AA, Toelg R, Sulimov D, Geist V, Richardt G. Long-term clinical outcome of rotational atherectomy followed by drug-eluting stent implantation in complex calcified coronary lesions. Catheter Cardiovasc Interv 2012; 81:285-91. [DOI: 10.1002/ccd.24367] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [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: 10/24/2011] [Revised: 01/01/2012] [Accepted: 02/12/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Mohamed Abdel-Wahab
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Radoy Baev
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Patrick Dieker
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Guido Kassner
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Ahmed A. Khattab
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Ralph Toelg
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Dmitriy Sulimov
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Volker Geist
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Gert Richardt
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
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Abdel-Wahab M, Mostafa AE, Geist V, Stöcker B, Gordian K, Merten C, Richardt D, Toelg R, Richardt G. Comparison of outcomes in patients having isolated transcatheter aortic valve implantation versus combined with preprocedural percutaneous coronary intervention. Am J Cardiol 2012; 109:581-6. [PMID: 22133754 DOI: 10.1016/j.amjcard.2011.09.053] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 09/29/2011] [Accepted: 09/29/2011] [Indexed: 12/12/2022]
Abstract
Coronary artery disease negatively affects the outcome of patients undergoing surgical aortic valve replacement and practice guidelines recommend revascularization at time of surgery. In patients undergoing transcatheter aortic valve implantation (TAVI), the impact of preprocedural percutaneous coronary intervention (PCI) on TAVI outcome has not been examined. We aimed in the present study to assess the feasibility and safety of performing PCI before TAVI and to evaluate procedural, 30-day, and 6-month clinical outcomes. We retrospectively analyzed 125 patients who underwent successful TAVI at a single institution and divided them into an isolated TAVI and a PCI + TAVI group. During the study period, a strategy of preprocedural PCI of all significant (>50%) lesions in major epicardial vessels was adopted. Study end points were adjudicated in accordance with the Valve Academic Research Consortium consensus on event definition. All patients were treated with the Medtronic CoreValve prosthesis (n = 55 with PCI + TAVI and n = 70 with isolated TAVI). Thirty-day mortality was 2% versus 6% for patients treated with PCI + TAVI versus isolated TAVI, respectively (p = 0.27). Neither periprocedural nor spontaneous myocardial infarction occurred in either group. Rates of 30-day stroke, major bleeding, major vascular complications, and the Valve Academic Research Consortium-defined combined safety end point (11% vs 13%, p = 0.74) did not differ between the 2 groups. Patients' symptoms significantly improved in the first month after TAVI, and extent of improvement did not differ between groups. Adverse events at 6 months were comparable. In conclusion, PCI before TAVI appears feasible and safe. Based on these early results revascularization should become an important consideration in patients with coronary artery disease undergoing TAVI.
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Sherif MA, Abdel-Wahab M, Beurich HW, Stöcker B, Zachow D, Geist V, Tölg R, Richardt G. Haemodynamic evaluation of aortic regurgitation after transcatheter aortic valve implantation using cardiovascular magnetic resonance. EUROINTERVENTION 2011; 7:57-63. [PMID: 21550904 DOI: 10.4244/eijv7i8a12] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [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: 12/29/2022]
Abstract
AIMS Echocardiography may underestimate the degree of paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve bioprosthesis due to inherent limitations of ultrasound imaging in the evaluation of implanted cardiac prostheses. We aimed to evaluate the accuracy and feasibility of cardiovascular magnetic resonance (CMR) in quantifying regurgitant volume (RV) and regurgitant fraction (RF) in patients treated with this bioprosthesis for severe calcific aortic stenosis, and to compare the results with echocardiography and aortography. METHODS AND RESULTS This study included 16 patients with a mean age of 78.7 years (eight women, eight men) who underwent successful TAVI using Medtronic CoreValve bioprosthesis. AR was evaluated by CMR, echocardiography, and aortography. Angiography was performed immediately after valve implantation. CMR and echocardiography were performed four weeks after valve implantation. There was a highly significant correlation between the CMR-derived and the angiographically-estimated degree of AR (r=0.86, p<0.001). On the other hand, there was only a limited correlation between CMR and echocardiography (r=0.374, p=0.15) as well as angiography and echocardiography (r=0.319, p=0.23) regarding the degree of AR. The weighted kappa for agreement between echocardiography and angiography was 0.14, for agreement between echocardiography and CMR 0.20, and for agreement between angiography and CMR 0.72. Echocardiography underestimated AR by one degree compared to CMR in five patients and 2 degrees in two patients; in six of these, the degree of AR obtained by CMR was similar to angiography. CONCLUSIONS In patients undergoing TAVI, comparisons between purely quantitative measurements of AR by CMR and qualitative assessment by angiography showed better correlations than those with echocardiography. This suggests that echocardiography may underestimate the degree of AR and CMR in these circumstances has a great potential in reliably measuring the severity of AR in a quantitative manner.
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Affiliation(s)
- Mohammad A Sherif
- Heart and Vascular Centre, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
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Mostafa AE, Geist V, Abdel-Wahab M. Ad-hoc percutaneous coronary intervention and transcatheter aortic valve implantation as a combined transfemoral procedure. J Invasive Cardiol 2011; 23:E102-E105. [PMID: 21562354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Coronary artery disease has been reported in more than 50% of patients with severe aortic stenosis above the age of 70 years. Combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) is associated with a higher operative risk. Concomitant coronary artery disease also increases the procedural risk of transcatheter aortic valve implantation (TAVI), and hence, a combined strategy for treating both entities needs to be carefully considered. Data regarding TAVI and percutaneous coronary intervention (PCI) as a combined percutaneous procedure are scarce. We report the case of an 84-year-old woman who presented with non-ST segment elevation myocardial infarction and impending pulmonary edema who was diagnosed with severe aortic stenosis and two-vessel coronary artery disease. Because of an elevated logistic Euroscore of 25% and her unstable presentation, percutaneous coronary revascularization and TAVI were successfully performed in a combined percutaneous transfemoral procedure. She had a smooth recovery and rehabilitation period with significant improvement in her symptoms and functional capacity. Thirty-day follow-up, including transthoracic echocardiography and cardiac magnetic resonance imaging, showed a well-functioning prosthetic valve and no signs of residual myocardial ischemia. We therefore conclude that combined PCI and TAVI is feasible and can be associated with good clinical outcomes in selected cases. Further data and experience are needed to evaluate this strategy.
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Affiliation(s)
- Ahmad E Mostafa
- Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the University of Kiel), Bad Segeberg, Germany
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Sherif MA, Nienaber CA, Toelg R, Abdel-Wahab M, Geist V, Schneider S, Senges J, Kuck KH, Tebbe U, Richardt G. Impact of smoking on the outcome of patients treated with drug-eluting stents: 1-year results from the prospective multicentre German Drug-Eluting Stent Registry (DES.DE). Clin Res Cardiol 2010; 100:413-23. [PMID: 21116637 DOI: 10.1007/s00392-010-0259-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 03/01/2010] [Accepted: 11/16/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cigarette smoking strongly increases morbidity and mortality from cardiovascular causes, but the relevance of smoking in patients treated with drug-eluting stents (DES) is unknown. AIMS To assess the impact of smoking on the presentation and outcome of patients treated with DES. METHODS AND RESULTS We analyzed data from the prospective multicentre German Drug-Eluting Stent Registry (DES.DE) and identified 1,122 patients who had never smoked and 1,052 patients who were current smokers. Smokers were younger (56.5 vs. 69.4 years, p < 0.0001), more often males, with less frequent diabetes and hypertension compared to non-smokers. Smokers presented more often with acute coronary syndromes. After a mean follow-up of 12.5 months, smokers had both higher mortality (4.6 vs. 2.7%, p < 0.05) and myocardial infarction (MI) rates (4.9 vs. 3%, p < 0.01). There was no significant difference between smokers and non-smokers in the rate of target vessel revascularization (9.8 vs. 11.4%, p = 0.26). Major adverse cardiac and cerebrovascular events (defined as the composite of death, MI and stroke, MACCE) were higher in smokers (10.6 vs. 6.1%, p < 0.001). Moreover, after adjustment for baseline clinical and angiographic variables, smoking continued to be a strong independent predictor for MACCE (OR = 2.34, 95% CI 1.49-3.68). In a subgroup analysis, we found that the increased risk of smoking was most prominent in patients presenting with stable angina pectoris (OR = 3.71, 95% CI 1.24-2.57, p < 0.05). Smoking almost doubled the risk for MACCE in acute MI patients, though this did not reach statistical significance (adjusted OR = 1.91, 95% CI 0.93-3.94, p = 0.74). CONCLUSION This large multicentre DES registry provides evidence that smokers treated with DES, despite lower incidence of predisposing risk factors for atherosclerosis, experience higher rates of death and MI compared to non-smokers, particularly in the setting of stable coronary artery disease. Smoking has only marginal effects on target vessel revascularization rates in patients treated with DES.
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Affiliation(s)
- Mohammad A Sherif
- Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
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Sherif MA, Abdel-Wahab M, Awad O, Geist V, El-Shahed G, Semmler R, Tawfik M, Khattab AA, Richardt D, Richardt G, Tölg R. Early hemodynamic and neurohormonal response after transcatheter aortic valve implantation. Am Heart J 2010; 160:862-9. [PMID: 21095273 DOI: 10.1016/j.ahj.2010.07.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [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: 03/14/2010] [Accepted: 07/13/2010] [Indexed: 01/20/2023]
Abstract
BACKGROUND The conventional surgical aortic bioprostheses used for treatment of aortic stenosis (AS) are inherently stenotic in nature. The more favorable mechanical profile of the Medtronic CoreValve bioprosthesis may translate into a better hemodynamic and neurohormonal response. PATIENTS AND METHODS The early hemodynamic and neurohormonal responses of 56 patients who underwent successful transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve bioprosthesis for severe symptomatic AS were compared with those of 36 patients who underwent surgical aortic valve replacement (SAVR) using tissue valves in the same period. RESULTS At baseline, patients in the TAVI and SAVR group had comparable indexed aortic valve area (0.33 ± 0.1 vs 0.34 ± 0.1 cm² , respectively; P = .69) and mean transvalvular gradient (51.1 ± 16.5 vs 53.1 ± 14.3 mm Hg, respectively; P = .56). At 30-day follow-up, mean transvalvular gradient was lower in the TAVI group than in the SAVR group (10.3 ± 4 vs 13.1 ± 6.2 mm Hg, respectively; P = .015), and the indexed aortic valve area was larger in the TAVI group (1.0 ± 0.14 vs 0.93 ± 0.13 cm²/m²; P = .017). There was a trend toward a higher incidence of moderate patient-prosthesis mismatch in the surgical group compared with the TAVI group (30.5% vs 17.8%, respectively; P = .11). The overall incidence of prosthetic regurgitation (any degree) was higher in the TAVI group than in the SAVR group (85.7% vs 16.7%, respectively; P < .00001). The left ventricular mass index decreased after TAVI (175.1 ± 61.8 vs 165.6 ± 57.2 g/m²; P = .0003) and remained unchanged after SAVR (165.1 ± 50.6 vs 161 ± 64.8 g/m²; P = .81). Similarly, NT-ProBNP decreased after TAVI (3,479 ± 2,716 vs 2,533 ± 1,849 pg/mL; P = .033) and remained unchanged after SAVR (1,836 ± 2,779 vs 1,689 ± 1,533 pg/mL; P = .78). There was a modest correlation between natriuretic peptides and left ventricular mass index in the whole cohort (r = 0.4, P = .013). CONCLUSION In patients with severe AS, TAVI resulted in lower transvalvular gradients and higher valve areas than SAVR. Such hemodynamic performance after TAVI may have contributed to early initiation of a reverse cardiac remodeling process and a decrease in natriuretic peptides.
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Affiliation(s)
- Mohammad A Sherif
- Cardiology Department, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
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Abdel-Wahab M, Khattab AA, Toelg R, Geist V, Liska B, Richardt G. Plaque characteristics of nonobstructive coronary lesions in diabetic patients: an intravascular ultrasound virtual histology analysis. J Cardiovasc Med (Hagerstown) 2010; 11:345-51. [DOI: 10.2459/jcm.0b013e328333ebb2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abdel-Wahab M, Saad M, Kynast J, Geist V, Sherif MA, Richardt G, Toelg R. Comparison of hospital mortality with intra-aortic balloon counterpulsation insertion before versus after primary percutaneous coronary intervention for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol 2010; 105:967-71. [PMID: 20346314 DOI: 10.1016/j.amjcard.2009.11.021] [Citation(s) in RCA: 81] [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: 07/24/2009] [Revised: 11/18/2009] [Accepted: 11/18/2009] [Indexed: 12/18/2022]
Abstract
Primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump counterpulsation (IABP) are established treatment modalities in acute myocardial infarction complicated by cardiogenic shock. We hypothesized that the insertion of the IABP before primary PCI might result in better survival of patients with cardiogenic shock compared to postponing the insertion to after primary PCI. We, therefore, retrospectively studied 48 patients who had undergone primary PCI with IABP because of cardiogenic shock complicating acute myocardial infarction (26 patients received the IABP before and 22 patients after primary PCI). No significant differences were present in the baseline clinical characteristics between the 2 groups. The mean number of diseased vessels was greater in the group of patients treated with the IABP before primary PCI (2.8 +/- 0.5 vs 2.3 +/- 0.7, p = 0.012), but the difference in the number of treated vessels was not significant. The peak creatine kinase and creatine kinase -MB levels were lower in patients treated with the IABP before primary PCI (median 1,077, interquartile range 438 to 2067 vs median 3,299, interquartile range 695 to 6,834, p = 0.047, and median 95, interquartile range 34 to 196 vs median 192, interquartile range 82 to 467, p = 0.048, respectively). In-hospital mortality and the overall incidence of major adverse cardiac and cerebrovascular events were significantly lower in the group of patients receiving the IABP before primary PCI (19% vs 59% and 23% vs 77%, p = 0.007 and p = 0.0004, respectively). Multivariate analysis identified renal failure (odds ratio 15.2, 95% confidence interval 3.13 to 73.66) and insertion of the IABP after PCI (odds ratio 5.2, 95% confidence interval 1.09 to 24.76) as the only independent predictors of in-hospital mortality. In conclusion, the results of the present study suggest that patients with cardiogenic shock complicating acute myocardial infarction who undergo primary PCI assisted by IABP have a more favorable in-hospital outcome and lower in-hospital mortality than patients who receive IABP after PCI.
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