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Klüß C, Giesbrecht A, Rudloff M, von Dossow V, Sandica E, Gummert J. Practical training concept for perfusionists at the heart and diabetes center Nordrhein-Westfalen. Perfusion 2024:2676591241248539. [PMID: 38647438 DOI: 10.1177/02676591241248539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Increasing regulations and requirements of advisory bodies, in particular the Joint Federal Committee and the Medical Service of the health insurance funds, make it necessary to employ only demonstrably well-trained perfusionists. The minimum requirement for this staff is EBCP certification. Currently there is limited availability of such specialists on the German market. Therefore, the qualification of young people in this area is of central importance. The aim of this paper is to strengthen the training of perfusionists at our centre, to standardise the process and to provide the respective student with a "roadmap" to their internship. MATERIAL & METHODS The structure is based on a rough division of the 24 weeks of internship. This is described in detail in the following and is backed up with the learning objectives for the respective time periods. RESULTS At our centre, practical training has been standardized and clear responsibilities have been defined. Furthermore, as a centre of maximum care in the field of cardiac surgery, we can offer students the necessary number of perfusions in just six months to meet the requirements of the ECBP for practical training. According to this concept, 20 perfusionists have been successfully trained in the last 8 years. All of them have passed the exams and have been certified according to EBCP. CONCLUSION The aim of the practical semester is for the student to be in a position at the end of the semester to independently supervise simple cardiac surgery procedures with the aid of the Extra- Corporal Circulation (ECC) and to carry this out in accordance with the currently valid guidelines and directives (1-8) and the departmental procedural instructions based on them. Great emphasis is placed to the students becoming aware of their competence to act, knowing their limits and being able to assess when these limits have been reached and the involvement of experienced colleagues is necessary to ensure patient safety.
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Affiliation(s)
- Christian Klüß
- Heart and Diabetes Center NRW, Department of Clinical Perfusion, Bad Oeynhausen, Germany
| | - André Giesbrecht
- Heart and Diabetes Center NRW, Department of Clinical Perfusion, Bad Oeynhausen, Germany
| | - Markus Rudloff
- Heart and Diabetes Center NRW, Department of Clinical Perfusion, Bad Oeynhausen, Germany
| | - Vera von Dossow
- Heart and Diabetes Center NRW, Institute of Anaesthesiology and Pain Therapy, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Eugen Sandica
- Heart and Diabetes Center NRW, Department of Pediatric Cardiac Surgery and Congenital Heart Defects, Bad Oeynhausen, Germany
| | - Jan Gummert
- Heart and Diabetes Center NRW, Department of Thoracic and Cardiovascular Surgery, Ruhr University Bochum, Bad Oeynhausen, Germany
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Rohde S, Miera O, Sliwka J, Sandica E, Amodeo A, Veen K, de By TMMH, Bogers AJJC, Schweiger M. Durable left ventricular assist device explantation following recovery in paediatric patients: Determinants and outcome after explantation. Eur J Cardiothorac Surg 2024; 65:ezae126. [PMID: 38613845 DOI: 10.1093/ejcts/ezae126] [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: 09/19/2023] [Revised: 01/31/2024] [Accepted: 04/11/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES Myocardial recovery in children supported by a durable left ventricular assist device is a rare, but highly desirable outcome because it could potentially eliminate the need for a cardiac transplant and the lifelong need for immunosuppressant therapy and the risk of complications. However, experience with this specific outcome is extremely limited. METHODS All patients < 19 years old supported by a durable left ventricular assist device from the European Registry for Patients with Mechanical Circulatory Support database were included. Participating centres were approached for additional follow-up data after explantation. Associated factors for explantation due to myocardial recovery were explored using Cox proportional hazard models. RESULTS The incidence of recovery in children supported by a durable left ventricular assist device was 11.7% (52/445; median duration of support, 122.0 days). Multivariable analyses showed body surface area (hazard ratio 0.229; confidence interval 0.093-0.565; P = 0.001) and a primary diagnosis of myocarditis (hazard ratio 4.597; confidence interval 2.545-8.303; P < 0.001) to be associated with recovery. Left ventricular end-diastolic diameter in children with myocarditis was not associated with recovery. Follow-up after recovery was obtained for 46 patients (88.5%). Sustained myocardial recovery was reported in 33/46 (71.7%) at the end of the follow-up period (28/33; >2 year). Transplants were performed in 6/46 (11.4%) (in 5 after a ventricular assist device was reimplanted). Death occurred in 7/46 (15.2%). CONCLUSIONS Myocardial recovery occurs in a substantial portion of paediatric patients supported with durable left ventricular assist devices, and sustainable recovery is seen in around three-quarters of them. Even children with severely dilated ventricles due to myocarditis can show recovery. Clinicians should be attentive to (developing) myocardial recovery. These results can be used to develop internationally approved paediatric weaning guidelines.
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Affiliation(s)
- Sofie Rohde
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Antonio Amodeo
- Heart Failure, Transplant and MCS Unit, Bambino Gesù Children Hospital & Research Institute, Rome, Italy, Catholic University of Sacred Heart, Department of Cardiac Surgery, Rome, Italy
| | - Kevin Veen
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Ad J J C Bogers
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Martin Schweiger
- Children's Hospital Zurich, Pediatric Heart Centre, Department for congenital heart surgery, Zurich, Switzerland
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Bruhs J, Sandica E, Laser K, Grohmann J, Goerg R, Hummel J, Molatta S, Schubert S. Long-Term Experience with Heart Transplantation in Patients with Congenital Heart Disease - Focus on Single Ventricle Patients and Vad. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Miera O, Sandica E, Kamphues A, Schweiger M, Stiller B, Kozlik-Feldmann R, Perez M, Schubert S, Zimpfer D. A Novel Mobile Driving System Improves the Quality of Life of Children Treated with a Paracorporeal Ventricular Assist Device. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Erdoes G, Koster A, Kadner A, Sandica E. Extracorporeal Membrane Oxygenation for Stage 1 Palliation: Early Bridge to Recovery Rather Than a Late Act of Pure Despair. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00177-5. [PMID: 37062663 DOI: 10.1053/j.jvca.2023.03.010] [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] [Received: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 04/18/2023]
Affiliation(s)
- Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Andreas Koster
- Institute of Anesthesiology and Pain Therapy, Heart, and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Alexander Kadner
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eugen Sandica
- Pediatric Heart Center and Center for Surgery Congenital Heart Defects, Heart, and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
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Kusmenkov E, Schubert S, Sandica E, Zakaraia I. Myokardinfarkt mit 12 Jahren—seltener Fall der familiären Hypercholesterinämie mit “small vessel disease” der Koronarien. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- E. Kusmenkov
- Zentrum für angeborene Herzfehler, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
| | - S. Schubert
- Zentrum für angeborene Herzfehler, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
| | - E. Sandica
- Zentrum für angeborene Herzfehler, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
| | - I. Zakaraia
- Zentrum für angeborene Herzfehler, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
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Rohde S, Sandica E, Veen K, Kraemer US, Thiruchelvam T, Miera O, Lopez MLP, Sliwka J, Amodeo A, Bogers AJJC, de By TMMH. Outcomes in small children on Berlin Heart EXCOR support: age and body surface area as clinical predictive factors. Eur J Cardiothorac Surg 2022; 63:6809124. [PMID: 36346169 PMCID: PMC9825200 DOI: 10.1093/ejcts/ezac516] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/25/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The Berlin Heart EXCOR (BHE) offers circulatory support across all paediatric ages. Clinically, the necessary care and the outcomes differ in various age groups. The EUROMACS database was used to study age- and size-related outcomes for this specific device. METHODS All patients <19 years of age from the EUROMACS database supported with a BHE between 2000 and November 2021 were included. Maximally selected rank statistics were used to determine body surface area (BSA) cut-off values. Multivariable Cox proportional hazard regression using ridge penalization was performed to identify factors associated with outcomes. RESULTS In total, 303 patients were included [mean age: 2.0 years (interquartile range: 0.6-8.0, males: 48.5%)]. Age and BSA were not significantly associated with mortality (n = 74, P = 0.684, P = 0.679). Factors associated with a transplant (n = 175) were age (hazard ratio 1.07, P = 0.006) and aetiology other than congenital heart disease (hazard ratio 1.46, P = 0.020). Recovery rates (n = 42) were highest in patients with a BSA of <0.53 m2 (21.8% vs 4.3-7.6% at 1 year, P = 0.00534). Patients with a BSA of ≥0.73 m2 had a lower risk of early pump thrombosis but a higher risk of early bleeding compared to children with a BSA of <0.73 m2. CONCLUSIONS Mortality rates in Berlin Heart-supported patients cannot be predicted by age or BSA. Recovery rates are remarkably high in the smallest patient category (BSA <0.53 m2). This underscores that the BHE is a viable therapeutic option, even for the smallest and youngest patients.
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Affiliation(s)
- Sofie Rohde
- Corresponding author. Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. E-mail: (S. Rohde)
| | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Kevin Veen
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ulrike S Kraemer
- Department of Paediatric Intensive Care, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Maria L Polo Lopez
- Department of Pediatric and Congenital Cardiac Surgery, La Paz University Hospital, Madrid, Spain
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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Racolta A, Ahn JHJ, Kantzis M, Milting H, Lauenroth V, Körperich H, Sandica E, Schubert S, Laser KT. Cardiac Muscle Training-A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric Population. Life (Basel) 2022; 12:life12111681. [PMID: 36362836 PMCID: PMC9698751 DOI: 10.3390/life12111681] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/02/2022]
Abstract
Patients with refractory heart failure due to chronic progressive cardiac myopathy (CM) may require mechanical circulatory support as a bridge to transplantation. A few patients can be weaned from support devices if recovery can be achieved. The identification of these patients is of great importance as recovery may be missed if the heart is unloaded by the ventricular assist device (VAD). Testing the load-bearing capacity of the supported left ventricle (LV) by temporarily and gradually reducing mechanical support during cardiac exercise can help identify responders and potentially aid the recovery process. An exercise training protocol was used in 3 patients (8 months, 18 months and 8 years old) with histological CM findings and myocarditis. They were monitored regularly using clinical information and functional imaging with VAD support. Echocardiographic examination included both conventional real-time 3D echocardiography (RT3DE) and speckle tracking (ST). A daily temporary reduction in pump rate (phase A) was followed by a permanent reduction in rate (phase B). Finally, pump stops of up to 30 min were performed once a week (phase C). The final decision on explantation was based on at least three pump stops. Two patients were weaned and successfully removed from the VAD. One of them was diagnosed with acute viral myocarditis. The other had chronic myocarditis with dilated myopathy and mild interstitial fibrosis. The noninvasive assessment of cardiac output and strain under different loading conditions during VAD therapy is feasible and helps identify candidates for weaning despite severe histological findings. The presented protocol, which incorporates new echocardiographic techniques for determining volume and deformation, can be of great help in positively guiding the process of individual recovery, which may be essential for selecting and increasing the number of patients to be weaned from VAD.
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Affiliation(s)
- Anca Racolta
- Clinic for Pediatric Cardiology, Center for Congenital Heart Defects, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Jae-Hyun Johannes Ahn
- Pediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Marinos Kantzis
- University Hospital Leicester, NHS Trust EMCHC, Leicester LE1 5WW, UK
| | - Hendrik Milting
- Erich and Hanna Klessmann Institute, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Volker Lauenroth
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Eugen Sandica
- Pediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Stephan Schubert
- Pediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kai Thorsten Laser
- Pediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
- Correspondence:
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9
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Rohde S, Sandica E, Veen K, Miera O, Amodeo A, Napoleone CP, Özbaran M, Sliwka J, Thiruchelvam T, Zimpfer D, Schubert S, Bogers AJJC, de By TMMH. Cerebrovascular accidents in paediatric patients supported by the Berlin Heart EXCOR. Eur J Cardiothorac Surg 2022; 62:6645748. [PMID: 35849328 PMCID: PMC9789740 DOI: 10.1093/ejcts/ezac381] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/16/2022] [Accepted: 07/13/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Ventricular assist device support as a bridge to transplant or recovery is a well-established therapy in children on the cardiac transplant waiting list. The goal of this study was to investigate the incidence of and the associated factors for cerebrovascular accidents in paediatric patients supported by a Berlin Heart EXCOR. METHODS All patients <19 years of age supported by a Berlin Heart EXCOR between January 2011 and January 2021 from the European Registry for Patients with Mechanical Circulatory Support were included. RESULTS In total, 230 patients were included. A total of 140 (60.9%) patients had a diagnosis of dilated cardiomyopathy. 46 patients (20.0%) sustained 55 cerebrovascular accidents, with 70.9% of the episodes within 90 days after the ventricular assist device was implanted. The event rate of cerebrovascular accidents was highest in the first era (0.75). Pump thrombosis and secondary need for a right ventricular assist device were found to be associated with a cerebrovascular accident (hazard ratio 1.998, P = 0.040; hazard ratio 11.300, P = 0.037). At the 1-year follow-up, 44.4% of the patients had received a transplant, 13.1% were weaned after recovery and 24.5% had died. Event rates for mortality showed a significantly decreasing trend. CONCLUSIONS Paediatric ventricular assist device support is associated with important adverse events, especially in the early phase after the device is implanted. Pump thrombosis and the need for a secondary right ventricular assist device are associated with cerebrovascular accidents. Furthermore, an encouragingly high rate of recovery in this patient population was shown, and death rates declined. More complete input of data into the registry, especially concerning anticoagulation protocols, would improve the data.
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Affiliation(s)
- Sofie Rohde
- Corresponding author. Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. e-mail: (S. Rohde)
| | | | - Kevin Veen
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Carlo Pace Napoleone
- Pediatric Cardiac Surgery Department, Regina Margherita Children’s Hospital, Torino, Italy
| | | | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | | | - Stephan Schubert
- Center of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center North Rhine Westfalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Ad J J C Bogers
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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de By TMMH, Schweiger M, Hussain H, Amodeo A, Martens T, Bogers AJJC, Damman K, Gollmnan-Tepeköylü C, Hulman M, Iacovoni A, Krämer U, Loforte A, Napoleone CP, Němec P, Netuka I, Özbaran M, Polo L, Pya Y, Ramjankhan F, Sandica E, Sliwka J, Stiller B, Kadner A, Franceschini A, Thiruchelvam T, Zimpfer D, Meyns B, Berger F, Miera O. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): third Paediatric (Paedi-EUROMACS) report. Eur J Cardiothorac Surg 2022; 62:6618527. [PMID: 35758622 DOI: 10.1093/ejcts/ezac355] [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] [Received: 02/21/2022] [Revised: 05/23/2022] [Accepted: 06/25/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Children's Hospital Zürich, Zürich, Switzerland
| | | | | | | | - Ad J J C Bogers
- Department of Cardio-thoracic surgery, Erasmus MC, Rotterdam, Netherlands
| | - Kevin Damman
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | | | | | - Ulrike Krämer
- Department of Pediatric Intensive Care, Erasmus MC, Rotterdam, Netherlands
| | | | - Carlo Pace Napoleone
- Pediatric Cardiac Surgery Department, Regina Margherita Children's Hospital, Torino, Italy
| | - Petr Němec
- Center for Cardiovascular and Transplant Surgery Brno
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | - Luz Polo
- La Paz University Hospital, Madrid, Spain
| | - Yuri Pya
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | | | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Germany
| | - Alexander Kadner
- Department of Herz- und Gefässchirurgie, University Hospital Bern, Switzerland
| | | | | | | | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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Zimpfer D, Hoerer J, Sandica E, Meyns B, DeRita F, Menon AK. PEDS2: Development and First Clinical Experience Of A Novel Cannula For Sub-Pulmonary Mechanical Circulatory Support In Patients With Failing Fontan Circulation. ASAIO J 2022. [DOI: 10.1097/01.mat.0000841100.43307.6a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Laser KT, Hofs A, Salewski A, Mantsch H, Spannring S, Bergunde I, Sandica E, Schubert S, Pohrisch J. Specific Developmental Disorders of Scholastic Skills Can Successfully Be Treated with Individualized Cognitive and Metacognitive Strategies in Children with Complex Congenital Heart Disease. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - A. Hofs
- Georgstr. 11, Bad Oeynhausen, Deutschland
| | | | - H. Mantsch
- Georgstr. 11, Bad Oeynhausen, Deutschland
| | | | - I. Bergunde
- Der Bildungskompass Inh. Julia Pohrisch, Bad Oeynhausen, Deutschland
| | - E. Sandica
- Herz-,Diabetes- Zentrum, Bad Oeynhausen, Deutschland
| | | | - J. Pohrisch
- University of Kaiserslautern, Kaiserslautern, Deutschland
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Laser KT, Gärtner A, Stanasiuk C, Klingel K, Laser V, M-P H, Sandica E, Schubert S, Milting H. High Prevalence of Genetic Etiologies in 105 Pediatric Patients with Manifestation of Severe and End-Stage Congestive Heart Failure—What Can We Learn? Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - A. Gärtner
- Georgstr. 11, Bad Oeynhausen, Deutschland
| | | | - K. Klingel
- Cardiopathology, Institue for Pathology and Neuropathology, Tübingen, Deutschland
| | - V. Laser
- Schillerstr. 8, Bad Oeynhausen, Deutschland
| | - Hitz M-P
- Arnold- Heller Str. 3, Haus 9, Kiel, Deutschland
| | - E. Sandica
- Herz-,Diabetes- Zentrum, Bad Oeynhausen, Deutschland
| | | | - H. Milting
- Herz- und Diabeteszentrum NRW, Georgstraße, Bad Oeynhausen, Germany, Bad Oeynhausen, Deutschland
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Boethig D, Avsar M, Bauer U, Beerbaum P, Berger F, Cesnjevar R, Dähnert I, Dittrich S, Ewert P, Haverich A, Hörer J, Kostelka M, Photiadis J, Sandica E, Sarikouch S, Schubert S, Urban A, Westhoff-Bleck M, Bobylev D, Horke A. Lifetime Endocarditis Risk with Congenital Heart Disease and Pulmonary Valve Prosthesis (PVP): Results from the German Registry for Congenital Heart Defects (CHD). Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - M. Avsar
- Cardiac, thoracic, transplantation and vascular surgery, Hannover Medical School, Hanover, Deutschland
| | - U. Bauer
- Nationales Register Angeborene Herzfehler, Berlin, Deutschland
| | - P. Beerbaum
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - F. Berger
- Augustenburger Platz 1, Berlin, Deutschland
| | | | - I. Dähnert
- Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | | | - P. Ewert
- German Heart Centre Munich / Deutsches Herzzentrum München, München, Deutschland
| | - A. Haverich
- Carl-Neuberg-Straße 1, Hannover, Deutschland
| | | | | | | | - E. Sandica
- Herz-, Diabetes-Zentrum, Bad Oeynhausen, Deutschland
| | | | | | - A. Urban
- Nationales Register Angeborene Herzfehler, Berlin, Deutschland
| | | | - D. Bobylev
- Carl-Neuberg-Straße 1, Hannover, Deutschland
| | - A. Horke
- Carl-Neuberg-Str. 1, Hannover, Deutschland
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Boethig D, Avsar M, Bauer UMM, Sarikouch S, Beerbaum P, Berger F, Cesnjevar R, Dähnert I, Dittrich S, Ewert P, Haverich A, Hörer J, Kostelka M, Photiadis J, Sandica E, Schubert S, Urban A, Bobylev D, Horke A. Pulmonary valve prostheses: patient's lifetime procedure load and durability. Evaluation of the German National Register for Congenital Heart Defects. Interact Cardiovasc Thorac Surg 2021; 34:297-306. [PMID: 34436589 DOI: 10.1093/icvts/ivab233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We evaluated 4384 procedures performed between 1957 and 2018, collected in the National Register for Congenital Heart Defects, conducted on 997 patients with 1823 pulmonary valve replacements (PVRs), including 226 implanted via catheter [transcatheter valve (TCV)]. Main study targets are as follows: TCV benefit, valve type durability, decade-wise treatment changes and procedure frequencies over the lifetime of a PVR patient. METHODS We studied TCV impact on surgical valve replacement (via Kaplan-Meier); pulmonary valve type-specific performance (Kaplan-Meier and Cox regressions with age group as stratification or ordinary variable); procedure interval changes over the decades (Kaplan-Meier); procedure load, i.e. frequency of any procedure/surgical PVR/interventional or surgical PVR by patient age (multistate analyses). RESULTS TCV performance was equivalent to surgical PVRs and extended durability significantly. Homografts were most durable; Contegras lasted comparably less in older; and Hancock devices lasted less in younger patients. Matrix P-valves showed poorer performance. Age group stratification improves the precision of valve-specific explantation hazard estimations. The current median interval between procedures is 2.6 years; it became significantly shorter in most age groups below 40 years. At 30 years, 80% of patients had undergone ≥3 procedures, 20% ≥3 surgical PVRs and 42% ≥3 surgical or interventional PVRs. CONCLUSIONS TCVs doubled freedom from explantation of conventional valves. Homografts' age group-specific explantation hazard ratio was lowest; Matrix P's hazard ratio was highest. Age-stratified Cox regressions improve the precision of prosthesis durability evaluations. The median time between procedures for PVR patients shortened significantly to 2.6 years. At 30 years, 42% had ≥3 PVRs.
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Affiliation(s)
- Dietmar Boethig
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany.,Department of Pediatric Cardiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany
| | - Murat Avsar
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, German Centre for Cardiovascular Research (DZHK), Berlin, Germany.,German Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Samir Sarikouch
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany
| | - Felix Berger
- Department of Congenital HeartDisease/Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany.,Department of Pediatric Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Ingo Dähnert
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Clinic for Pediatric Cardiology, Leipzig, Germany
| | - Sven Dittrich
- Divisions of Pediatric Cardiology, University of Erlangen, Erlangen, Germany.,Division of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Peter Ewert
- Department of Paediatric Cardiology and Congenital Heart Defects and Congenital Heart Surgery, German Heart Centre of the Technical University of Munich, Munich, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Jürgen Hörer
- Department of Paediatric Cardiology and Congenital Heart Defects and Congenital Heart Surgery, German Heart Centre of the Technical University of Munich, Munich, Germany
| | - Martin Kostelka
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Clinic for Pediatric Cardiology, Leipzig, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Disease, German Heart Institute, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany.,Department of Pediatric Cardiology and Congenital Heart Surgery, German Heart Institute, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany.,Department of Pediatric Heart Surgery, German Heart Institute, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany
| | - Eugen Sandica
- Department of Congenital Heart Disease, Heart and Diabetes Centre, Bad Oeynhausen, Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease, Heart and Diabetes Centre, Bad Oeynhausen, Germany
| | - Aleksandra Urban
- National Register for Congenital Heart Defects, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Dmitry Bobylev
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Alexander Horke
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
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de By TMMH, Antonides CFJ, Schweiger M, Sliwka J, Davies B, Berger F, Hübler M, Özbaran M, Maruszewski B, Pace Napoleone C, Zimpfer D, Sandica E, Antretter H, Meyns B, Miera O. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): second EUROMACS Paediatric (Paedi-EUROMACS) report. Eur J Cardiothorac Surg 2021; 57:1038-1050. [PMID: 32364221 DOI: 10.1093/ejcts/ezaa132] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES A second paediatric report has been generated from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). The purpose of EUROMACS, which is operated by the European Association for Cardio-Thoracic Surgery, is to gather data related to durable mechanical circulatory support for scientific purposes and to publish reports with respect to the course of mechanical circulatory support therapy. Since the first report issued, efforts to increase compliance and participation have been extended. Additionally, the data provided the opportunity to analyse patients of younger age and lower weight. METHODS Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (≤19 years of age) performed from 1 January 2000 to 1 July 2019 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events including neurological dysfunction, device malfunction, major infection and bleeding. RESULTS Twenty-nine hospitals contributed 398 registered implants in 353 patients (150 female, 203 male) to the registry. The most frequent aetiology of heart failure was any form of cardiomyopathy (61%), followed by congenital heart disease and myocarditis (16.4% and 16.1%, respectively). Competing outcomes analysis revealed that a total of 80% survived to transplant or recovery or are ongoing; at the 2-year follow-up examination, 20% died while on support. At 12 months, 46.7% received transplants, 8.7% were weaned from their device and 18.5% died. The 3-month adverse events rate was 1.69 per patient-year for device malfunction including pump exchange, 0.48 for major bleeding, 0.64 for major infection and 0.78 for neurological events. CONCLUSIONS The overall survival rate was 81.5% at 12 months following ventricular assist device implant. The comparison of survival rates of the early and later eras shows no significant difference. A focus on specific subgroups showed that survival was less in patients of younger age (<1 year of age) (P = 0.01) and lower weight (<20 kg) (P = 0.015). Transplant rates at 6 months continue to be low (33.2%) The fact that the EUROMACS registry is embedded within the European Association for Cardio-Thoracic Surgery Quality Improvement Programme offers opportunities to focus on improving outcomes.
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Affiliation(s)
- Theo M M H de By
- EUROMACS, European Association for Cardio-Thoracic Surgery (EACTS), Windsor, UK
| | | | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Children's Hospital Zürich, Zürich, Switzerland
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Ben Davies
- Great Ormond Street Hospital, London, UK
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Michael Hübler
- Department of Congenital Pediatric Surgery, Children's Hospital Zürich, Zürich, Switzerland
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Ege Universitesi Tip Fakültesi, Izmir, Turkey
| | - Bohdan Maruszewski
- Pediatric Cardiothoracic Surgery Department, Children's Memorial Hospital, Warsaw, Poland
| | - Carlos Pace Napoleone
- Pediatric Cardiac Surgery Department, Regina Margherita Children's Hospital, Torino, Italy
| | | | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Germany
| | | | - Bart Meyns
- Cardiale Heelkunde, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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17
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Sandica E. Commentary: Fontan circulation with lymphatic failure: Was the Holy Grail finally found? JTCVS Tech 2021; 7:263-264. [PMID: 34318268 PMCID: PMC8311590 DOI: 10.1016/j.xjtc.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Eugen Sandica
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
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18
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Menon A, Sandica E, Akintürk H, Derita F, Meyns B, D'udekem Y, Photiadis J, Cesnjevar R, Ovroutski S, Hübler M, Zimpfer D, Hörer J, Hagl C, Rambach A, Berger F, Miera O. A Novel Method to Bridge Failing Fontan Patients to Heart Transplantation: The Re-Give Study. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Ferentzi H, Rippe RCA, Latour JM, Schubert S, Girch A, Jönebratt Stocker M, Pfitzer C, Photiadis J, Sandica E, Berger F, Schmitt KRL. Family-Centered Care at Pediatric Cardiac Intensive Care Units in Germany and the Relationship With Parent and Infant Well-Being: A Study Protocol. Front Pediatr 2021; 9:666904. [PMID: 34458208 PMCID: PMC8397409 DOI: 10.3389/fped.2021.666904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Rationale and Aim: Infants with Congenital Heart Disease (CHD) are at risk for neurodevelopmental delays, emotional, social and behavioral difficulties. Hospitalization early in life and associated stressors may contribute to these challenges. Family-centered Care (FCC) is a health care approach that is respectful of and responsive to the needs and values of a family and has shown to be effective in improving health outcomes of premature infants, as well as the mental well-being of their parents. However, there is limited empirical data available on FCC practices in pediatric cardiology and associations with parent and infant outcomes. Methods and Analysis: In this cross-sectional study, we will explore FCC practices at two pediatric cardiac intensive care units in Germany, assess parent satisfaction with FCC, and investigate associations with parental mental well-being and parenting stress, as well as infant physical and mental well-being. We will collect data of 280 infants with CHD and their families. Data will be analyzed using multivariate statistics and multilevel modeling. Implications and Dissemination: The study protocol was approved by the medical ethics committees of both partner sites and registered with the German registry for clinical trials (NR DRKS00023964). This study serves as a first step to investigate FCC practices in a pediatric cardiology setting, providing insight into the relationship between FCC and parent and infant outcomes in a population of infants with CHD. Results will be disseminated in peer-reviewed journals.
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Affiliation(s)
- Hannah Ferentzi
- Department of Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Ralph C A Rippe
- Research Methods and Statistics, Institute of Education and Child Studies, Leiden University, Leiden, Netherlands
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Stephan Schubert
- Center for Congenital Heart Disease, Heart- and Diabetescenter NRW, University Clinic of Ruhr-University Bochum (RUB), Bad Oeynhausen, Germany
| | - Alona Girch
- Department of Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Pediatric Cardiology, Charité University Hospital Berlin, Berlin, Germany
| | - Michaela Jönebratt Stocker
- Department of Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Pediatric Cardiology, Charité University Hospital Berlin, Berlin, Germany
| | - Constanze Pfitzer
- Department of Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Pediatric Cardiology, Charité University Hospital Berlin, Berlin, Germany.,Berlin Institute of Health, Charité University Hospital Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Eugen Sandica
- Center for Congenital Heart Disease, Heart- and Diabetescenter NRW, University Clinic of Ruhr-University Bochum (RUB), Bad Oeynhausen, Germany
| | - Felix Berger
- Department of Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Pediatric Cardiology, Charité University Hospital Berlin, Berlin, Germany
| | - Katharina R L Schmitt
- Department of Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Pediatric Cardiology, Charité University Hospital Berlin, Berlin, Germany
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20
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Gyoten T, Rojas SV, Fox H, Schramm R, Hakim-Meibodi K, Ruiz-Cano M, Gummert JF, Morshuis M, Sandica E. Mechanical circulatory support as a bridge to candidacy in adults with transposition of the great arteries and a systemic right ventricle. Eur J Cardiothorac Surg 2020; 59:ezaa373. [PMID: 33226086 DOI: 10.1093/ejcts/ezaa373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Clinical experience with continuous flow ventricular assist devices (VADs) in patients with transposition of the great arteries (TGA) including dextro-TGA and congenitally corrected TGA is rare, and indications as well as potential benefits or specific hurdles remain unclear. Therefore, our goal was to report on our experience regarding VAD therapy in adult patients with TGA as a bridge to candidacy. METHODS We performed a single-centre retrospective study of all adult patients with TGA with systemic right ventricular failure who had continuous flow VAD implants between 2010 and 2018. Study end points were all causes of death, major cardiac and cerebrovascular adverse events or pump thrombosis. Follow-up continued until the time of the heart transplant. RESULTS A total of 6 patients (4 men) had a continuous flow VAD implanted in the context of a failing systemic right ventricle (dextro-TGA after the Mustard procedure: n = 3; congenitally corrected TGA: n = 3). Demographics: mean age 32 ± 5.7 years; median Interagency Registry for Mechanically Assisted Circulatory Support: level II (range 1-4), mean pulmonary artery 48 ± 13 mmHg, mean pulmonary vascular resistance 5.6 ± 3.5 Wood units. Postoperative data: intensive care unit stay: 16 ± 9.7 days; in-hospital survival: 100%; no early VAD-related complications occurred. Mean follow-up: 33 ± 18 months; persistent left-side paresis: n = 1; minor (non-disabling) stroke: n = 2. Post-VAD pulmonary artery: 19 ± 3.4 mmHg; P < 0.005; post-VAD pulmonary resistance: 2.2 ± 0.55 Wood units; P = 0.066. Four patients had heart transplants after a mean waiting time of 30 months after the VAD was implanted; 2 patients are still on the waiting list (waiting time: 52 and 24 months). CONCLUSIONS Continuous flow VAD therapy is a feasible therapeutic option in adult patients with TGA and a failing systemic right ventricle as a bridge to candidacy and a bridge to a heart transplant.
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Affiliation(s)
- Takayuki Gyoten
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Maria Ruiz-Cano
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Eugen Sandica
- Center for Congenital Heart Defects, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
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21
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Haas NA, Bach S, Vcasna R, Laser KT, Sandica E, Blanz U, Jakob A, Dietl M, Fischer M, Kanaan M, Lehner A. The risk of bacterial endocarditis after percutaneous and surgical biological pulmonary valve implantation. Int J Cardiol 2018; 268:55-60. [DOI: 10.1016/j.ijcard.2018.04.138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/30/2018] [Indexed: 02/04/2023]
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22
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de By TMMH, Schweiger M, Waheed H, Berger F, Hübler M, Özbaran M, Maruszewski B, Napoleone CP, Loforte A, Meyns B, Miera O, Antretter H, Krachak V, Vanbelleghem Y, Meyns B, Němec P, Netuka I, Guihaire J, Sandica E, Miera O, Stiller B, Bodor G, Amodeo A, Iacovoni A, Pace Napoleone C, Loforte A, Pya Y, Bogers A, Ramjankhan F, Maruszewski B, Guereta L, Schweiger M, Carrel T, Sezgin A, Özbaran M, Pektok E. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): first EUROMACS Paediatric (Paedi-EUROMACS) report. Eur J Cardiothorac Surg 2018; 54:800-808. [DOI: 10.1093/ejcts/ezy298] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 07/24/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES:
EUROMACS is a registry of the European Association for Cardio-Thoracic Surgery (EACTS) whose purpose is to gather clinical data related to durable mechanical circulatory support for scientific purposes and to publish annual reports. Because the treatment of children with end-stage heart failure has several significantly different characteristics than the treatment of adults, data and outcomes of interventions are analysed in this dedicated paediatric report.
METHODS:
Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (≤19 years of age) performed from 1 January 2000 to 31 December 2017 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events.
RESULTS:
Twenty-five hospitals contributed 237 registered implants in 210 patients (81 ♀, 129 ♂) to the registry. The most frequent diagnosis was any form of cardiomyopathy (71.4%) followed by congenital heart disease (18.6%). Overall mean support time on a device was 11.6 months (±16.5 standard deviation). A total of 173 children (82.4%) survived to transplant, recovery or are ongoing; 37 patients (17.6%) died while on support within the observed follow-up time. At 12 months 38% of patients received transplants, 7% were weaned from their device and 15% died. At 24 months, 51% of patients received transplants, 17% died while on support, 22% were on a device and 9% were explanted due to myocardial recovery. The adverse events rate per 100 patient-months was 11.97 for device malfunction, 2.83 for major bleeding, 2.83 for major infection and 1.52 for neurological events within the first 3 months after implantation.
CONCLUSIONS:
The first paediatric EUROMACS report reveals a low transplant rate in European countries within the first 2 years of implantation compared to US data. The 1-year survival rate seems to be satisfactory. Device malfunction including pump chamber changes due to thrombosis was the most frequent adverse event.
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Affiliation(s)
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Children's Hospital, Zürich, Switzerland
| | - Hina Waheed
- Quality and Outcomes Research Unit, University Hospital Birmingham, Birmingham, UK
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Michael Hübler
- Department of Congenital Pediatric Surgery, Children's Hospital, Zürich, Switzerland
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Ege Üniversitesi Tıp Fakültesi, Izmir, Turkey
| | - Bohdan Maruszewski
- Pediatric Cardiothoracic Surgery Department, Children’s Memorial Hospital, Warsaw, Poland
| | - Carlo Pace Napoleone
- Department of Pediatrics, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Loforte
- Dipartimento di Chirurgia Cardio-Toraco-Vascolare e Trapianti, Policlinico S. Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Bart Meyns
- Cardiale Heelkunde, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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23
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Miera O, Schmitt KL, Akintuerk H, Boet A, Cesnjevar R, Chila T, Fleck T, Goldwasser R, Guereta LG, Heineking B, Hoerer J, Horke A, Hsia TY, Huebler M, Kansy A, Karimova A, Maruszewski B, Medrano C, Pawlak S, Reinhardt Z, Romlin B, Sandica E, Schmidt F, Schramm R, Schweiger M, Śliwka J, Stiller B, Thul J, Amodeo A. Antithrombotic therapy in pediatric ventricular assist devices: Multicenter survey of the European EXCOR Pediatric Investigator Group. Int J Artif Organs 2018; 41:385-392. [DOI: 10.1177/0391398818773040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives: Mechanical circulatory support for pediatric heart failure patients with the Berlin Heart EXCOR ventricular assist system is the only approved and established bridging strategy for recovery or heart transplantation. In recent years, the burden of thromboembolic events has led to modifications of the recommended antithrombotic therapy. Therefore, we aimed to assess modifications of antithrombotic practice among the European EXCOR Pediatric Investigator Group members. Methods: We sent a questionnaire assessing seven aspects of antithrombotic therapy to 18 European hospitals using the EXCOR device for children. Returned questionnaires were analyzed and identified antithrombotic strategies were descriptively compared to “Edmonton protocol” recommendations developed for the US EXCOR pediatric approval study. Results: Analysis of 18 received surveys revealed substantial deviations from the Edmonton protocol, including earlier start of heparin therapy at 6–12 h postoperatively and in 50% of surveyed centers, monitoring of heparin effectiveness with aPTT assay, administering vitamin K antagonists before 12 months of age. About 39% of centers use higher international normalized ratio targets, and platelet inhibition is changed in 56% including the use of clopidogrel instead of dipyridamole. Significant inter-center variability with multiple deviations from the Edmonton protocol was discovered with only one center following the Edmonton protocol completely. Conclusion: Current antithrombotic practice among European EXCOR users representing the treatment of more than 600 pediatric patients has changed over time with a trend toward a more aggressive therapy. There is a need for systematic evidence-based evaluation and harmonization of developmentally adjusted antithrombotic management practices in prospective studies toward revised recommendations.
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Affiliation(s)
- Oliver Miera
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Katharina L Schmitt
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Hakan Akintuerk
- Pediatric Heart Center, University Hospital Giessen, Justus Liebig University, Giessen, Germany
| | - Angele Boet
- Cardiac ICU, “Marie Lannelongue” Surgical Center, South Paris University Hospitals, Paris, France
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Teresa Chila
- Department of Pediatric Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
| | - Ranny Goldwasser
- Department of Pediatric Cardiology/Congenital Heart Disease, Heidelberg University Hospital, Heidelberg, Germany
| | - Luis G Guereta
- Pediatric Cardiology, University Hospital La Paz, Madrid, Spain
| | - Beatrice Heineking
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Juergen Hoerer
- Cardiac ICU, “Marie Lannelongue” Surgical Center, South Paris University Hospitals, Paris, France
| | - Alexander Horke
- Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Germany
| | - Tain Y Hsia
- Department of Pediatric Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Michael Huebler
- Department of Congenital Pediatric Surgery, Zurich Children’s Hospital, Zurich, Switzerland
| | - Andrzej Kansy
- Department of Cardiothoracic Surgery, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Ann Karimova
- Department of Pediatric Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Bohdan Maruszewski
- Department of Cardiothoracic Surgery, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Constancio Medrano
- Pediatric Cardiology Division, Hospital Materno Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Szymon Pawlak
- Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Zdenka Reinhardt
- Department of Pediatric Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Birgitta Romlin
- Department of Pediatric Anesthesia and Intensive Care, Queen Silvia Children’s Hospital, Gothenburg, Sweden
| | - Eugen Sandica
- Center for Congenital Heart Defects, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Florian Schmidt
- Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Germany
| | - René Schramm
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Zurich Children’s Hospital, Zurich, Switzerland
| | - Joanna Śliwka
- Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
| | - Josef Thul
- Pediatric Heart Center, University Hospital Giessen, Justus Liebig University, Giessen, Germany
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
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Sandica E. Reconstruction of the Dysfunctional Bicuspid Aortic Valve and a New Method for Aortic Valve Replacement. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E. Sandica
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Center NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
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De Rita F, Griselli M, Sandica E, Miera O, Karimova A, d'Udekem Y, Goldwasser R, Januszewska K, Amodeo A, Jurrmann N, Ersel S, Menon AK. Closing the gap in paediatric ventricular assist device therapy with the Berlin Heart EXCOR® 15-ml pump. Interact Cardiovasc Thorac Surg 2017; 24:768-771. [PMID: 28453795 DOI: 10.1093/icvts/ivw437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 11/03/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The Berlin Heart EXCOR ® (EXCOR) paediatric ventricular assist device is used worldwide for mechanical support of infants and small children with end-stage heart failure. A clinically important gap between the smallest EXCOR blood pump (10 ml) and the next larger size (25 ml) limited the choice of pump size in patients with a body surface area (BSA) between 0.33 and 0.5 m 2 . We present the first clinical experience from the early product surveillance (EPS) of the new EXCOR 15-ml blood pump. METHODS After CE and U.S. Food and Drug Administration approval in January 2013, 20 patients with a mean age of 1.6 years (range 0.5-3.5 years) and a mean BSA of 0.45 m 2 (range 0.33-0.59 m 2 ) were enrolled in the EPS. The main diagnosis was idiopathic cardiomyopathy in 13 patients; the majority ( n = 16) of children were in INTERMACS level 1 or 2. Data from high-volume paediatric transplant centres were collected prospectively for a defined follow-up period of 60 days after device implantation. RESULTS Mean time on the EXCOR 15-ml blood pump was 43 days; the survival rate was 100% at the end of the EPS period. Seven patients underwent a heart transplant from the device; 2 children were weaned; and 11 patients remained on support. Infection of cannula exit sites occurred in 3 patients. Two patients had minor thromboembolic strokes but made a complete neurological recovery. CONCLUSIONS The new EXCOR 15-ml blood pump demonstrated optimal ventricular assist device support of children with a BSA of 0.33-0.5 m 2 .
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Affiliation(s)
- Fabrizio De Rita
- Department of Paediatric Heart Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Massimo Griselli
- Department of Paediatric Heart Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Eugen Sandica
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Center Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Oliver Miera
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Ann Karimova
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, UK
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia
| | - Ranny Goldwasser
- Department of Pediatric Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
| | | | - Antonio Amodeo
- Department of Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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Miera O, Schmitt K, Menon A, Ersel S, Reiprich A, Akintürk H, Thul J, Karimova A, Cesnjevar R, Reinhardt Z, Goldwasser R, Heineking B, Schramm R, Romlin B, Kansy A, Maruszewski B, Sandica E, Pawlak S, Sliwka J, Schweiger M, Huebler M, Stiller B, Fleck T, Hoerer J, Boet A, Medrano C, Guereta L, Amodeo A. (733)Current Practice of Anticoagulation for Pediatric VAD Therapy - A Multi-Institutional European Survey of the EXCOR Pediatric Investigator Group (EEPIG). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Horke A, Tudorache I, Sandica E, Sarikouch S, Westhoff-Bleck M, Cebotari S, Haverich A, Bobylev D, Boethig D. Do Fresh Decellularized Pulmonary Artery Homografts Show Adaptive Growth? Considerations Twelve Years after Implantation of Various RVOT Conduits. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Horke
- Hannover Medical School, Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - I. Tudorache
- Hannover Medical School, Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - E. Sandica
- Herzzentrum Nordrhein-Westfalen, Kinderherzchirurgie und angeborene Herzfehler, Bad Oeynhausen, Germany
| | - S. Sarikouch
- Hannover Medical School, Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - M. Westhoff-Bleck
- Hannover Medical School, Kardiologie und Angiologie, Hannover, Germany
| | - S. Cebotari
- Hannover Medical School, Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - A. Haverich
- Hannover Medical School, Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - D. Bobylev
- Hannover Medical School, Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - D. Boethig
- Hannover Medical School, Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany
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Sandica E, Blanz U, Ben L, Schultz-Kaizler U, Kececioglu D, Laser K, Kirchner G, zu E, Morshuis M. Bad Oeynhausen Experience with Berlin Heart EXCOR in Children with Single- and Two-Ventricle Physiology. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- E. Sandica
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Center NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - U. Blanz
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Center NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - L. Ben
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Center NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - U. Schultz-Kaizler
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Center NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - D. Kececioglu
- Department for Pediatric Cardiology and Congenital Heart Defects, Heart and Diabetes Center NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - K.T. Laser
- Department for Pediatric Cardiology and Congenital Heart Defects, Heart and Diabetes Center NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - G. Kirchner
- Department for Pediatric Cardiology and Congenital Heart Defects, Heart and Diabetes Center NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - E. zu
- Department for Pediatric Cardiology and Congenital Heart Defects, Heart and Diabetes Center NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - M. Morshuis
- Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
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Racolta A, Milting H, Lauenroth V, Horst JP, Klusmeier E, Vcasna R, Kantzis M, Sandica E, Kececioglu D, Laser K. Can Cardiac Recovery in Chronic Myocarditis Be Influenced by Training during LVAD Support? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Racolta
- Herz- und Diabeteszentrum NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - H. Milting
- Herz- und Diabeteszentrum NRW, Klessmann-Institut (EHKI), Bad Oeynhausen, Germany
| | - V. Lauenroth
- Herz- und Diabeteszentrum NRW, VAD Koordination, Bad Oeynhausen, Germany
| | - J.-P. Horst
- Herz- und Diabeteszentrum NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - E. Klusmeier
- Herz- und Diabeteszentrum NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - R. Vcasna
- Herz- und Diabeteszentrum NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - M. Kantzis
- Herz- und Diabeteszentrum NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - E. Sandica
- Herz- und Diabeteszentrum NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - D. Kececioglu
- Herz- und Diabeteszentrum NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
| | - K.T. Laser
- Herz- und Diabeteszentrum NRW, Center for Congenital Heart Defects, Bad Oeynhausen, Germany
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Cheng CF, Klauke B, Smoktunowicz N, Ku HC, Li HF, Hsieh YT, Lin H, Gaertner-Rommel A, Kassner A, Baurichter D, Sandica E, Zu Knyphausen E, Laser T, Kececioglu D, Gummert J, Milting H, Vikhorev P, Montgiraud C, Copeland O, Munster A, Dos Remedios C, Messer A, Knoll R, Marston S. Heart Failure: From Protein to Phenotype37MicroRNA-494 reduces ATF3 expression and promotes heart failure in cardiac hypertrophic remodeling in vivo38A novel recessive plakophilin-2 gene mutation causes severe arrhythmogenic dilated cardiomyopathy and sudden cardiac death at young age39Investigation of titin expression in explanted hearts with familial dilated cardiomyopathy and TTN truncating variants. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw129] [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: 11/13/2022] Open
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Haas N, Happel C, Blanz U, Laser T, Kantzis M, Sandica E, Kececioglu D. Intraoperative Hybrid Stenting of Recurrent Coarctation and Arch Hypoplasia with Large Stents in Patients with Univentricular Hearts. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vcasna R, Bach S, Kantzis M, Racolta A, Laser K, Happel C, Kececioglu D, Sandica E, Haas N. Feasibility of Percutaneous Pulmonary Valve Implantation: Reasons for Failure and Contraindications. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fröhle M, Racolta A, Kantzis M, Laser K, Kececioglu D, Steinhard J, Sandica E, Haas N. Stenting a Stenotic Levoatriocardinal Vein in a Hypoplastic Left Heart Syndrome with An Intact Atrial Septum. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schmitz H, Hesse C, Grosbüsch S, Fröhle M, Meyer Z, Blanz U, Kececioglu D, Haas N, Sandica E. Multisystemic Smooth Muscle Dysfunction Syndrome:An Unusual Cause for a Gigantic PDA with Bilateral Mydriasis. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bach S, Vcasna R, Kantzis M, Laser T, Görg R, Kececioglu D, Sandica E, Haas N. The Risk of Bacterial Endocarditis after Percutaneous and Surgical Biological Pulmonary Valve Implantation. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Haas NA, Happel CM, Blanz U, Laser KT, Kantzis M, Kececioglu D, Sandica E. "Intraoperative hybrid stenting of recurrent coarctation and arch hypoplasia with large stents in patients with univentricular hearts". Int J Cardiol 2015; 204:156-63. [PMID: 26657614 DOI: 10.1016/j.ijcard.2015.11.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/19/2015] [Accepted: 11/22/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Obstruction of the reconstructed aortic arch, tubular hypoplasia and recurrent coarctation (RC) is an important risk factor in univentricular physiology. For the past two years we have adopted the concept of intraoperative hybrid stenting of RC and arch hypoplasia with large stents in patients with univentricular hearts as standard care procedure. METHOD/RESULT Retrospective analysis of the anatomy and procedural outcome of 14 patients was scheduled for intraoperative stenting of the aortic arch (12 during surgery for BCPS, 2 during Fontan completion). The median age was 5.3 months, weight 5.5 kg, height 62 cm. Five patients had tubular hypoplasia and 9 patients had distal stenosis of the aortic arch. Nine patients had a previous balloon dilatation. The mean diameter of the distal arch was 11.0mm, at the coarctation 5.1mm, at the level of the diaphragm 8.2mm (CoA-index 0.62). Intraoperative stenting was performed in 13/14 patients. Stents were implanted with a mean balloon diameter of 10.8mm (SD 3.4mm). The achieved final mean diameter was 9.8mm (mean, SD 2.8mm) with an oversized Coa-index of 1.2. There was no re-coarctation at a mean follow-up of 7.3 months (range 3 to 24), the maximum flow velocity of 2m/s across the stented lesion assessed by ECHO. CONCLUSION This hybrid approach is an easy and safe concept to manage recurrent aortic arch hypoplasia and stenosis. The use of large stents allows redilatation to adult size diameters later on.
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Affiliation(s)
- Nikolaus A Haas
- Department for Congenital Heart Defects, Ruhr University Bochum, Germany; Department for Pediatric Cardiology and Intensive Care, LMU-Campus Großhadern, Germany.
| | - Christoph M Happel
- Department for Congenital Heart Defects, Ruhr University Bochum, Germany
| | - Ute Blanz
- Department for Surgery of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
| | - Kai Thorsten Laser
- Department for Congenital Heart Defects, Ruhr University Bochum, Germany
| | - Marinos Kantzis
- Department for Congenital Heart Defects, Ruhr University Bochum, Germany
| | - Deniz Kececioglu
- Department for Congenital Heart Defects, Ruhr University Bochum, Germany
| | - Eugen Sandica
- Department for Surgery of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
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Sandica E, Blanz U, Mime LB, Schultz-Kaizler U, Kececioglu D, Haas N, Kirchner G, zu Knyphausen E, Lauenroth V, Morshuis M. Long-Term Mechanical Circulatory Support in Pediatric Patients. Artif Organs 2015; 40:225-32. [PMID: 26411865 DOI: 10.1111/aor.12552] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This retrospective study reviews our results regarding the long-term support in pediatric patients using two ventricular assist systems between January 2008 and April 2014. We implanted the Berlin Heart EXCOR in 29 patients (median age 3.4 years [interquartile range (IQR) 0.2-16.5], median weight 13 kg [IQR 4.2-67.2]). Twenty-two patients (75.8%) received a left ventricular assist device. Three patients (10.3%) had single-ventricle physiology. One patient (3.4%) had mechanical mitral valve prosthesis. The HeartWare System was implanted in nine patients. The median age was 15.6 years (IQR 12.2-17.9), and the median weight was 54.9 kg (IQR 27.7-66). In the Berlin Heart group, the median support time was 65 days (IQR 4-619), with 3647 days of cardiac support. Nineteen patients (65.5%) were transplanted, six patients (20.7%) recovered, one patient (3.4%) is on support, and three patients (10.3%) died on support. Survival rate was 89.7%. Fourteen blood pumps had been exchanged. Four patients (13.8%) had local signs of infection, and three patients (10.3%) had neurological complications. In the HeartWare group, the median support time was 180 days (IQR 1-1124), with 2839 days of cardiac support. Four patients (44.4%) had local signs of infection, and three (33.3%) had neurological complications. Eight patients (88.9%) have been transplanted, and one patient (11.1%) died on support. Survival rate was 88.9%. Excellent survival is possible after long-term mechanical circulatory support in patients with two- and single-ventricle physiology with a low rate of adverse events.
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Affiliation(s)
- Eugen Sandica
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Ute Blanz
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Lotfi Ben Mime
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Ursula Schultz-Kaizler
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Deniz Kececioglu
- Department of Paediatric Cardiology and Congenital Heart Defects, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Nikolaus Haas
- Department of Paediatric Cardiology and Congenital Heart Defects, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Guenther Kirchner
- Department of Paediatric Cardiology and Congenital Heart Defects, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Edzard zu Knyphausen
- Department of Paediatric Cardiology and Congenital Heart Defects, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Volker Lauenroth
- Department of Thoracic and Cardiac Surgery, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Department of Thoracic and Cardiac Surgery, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
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Sandica E, Boethig D, Blanz U, Goerg R, Haas NA, Laser KT, Kececioglu D, Bertram H, Sarikouch S, Westhoff-Bleck M, Beerbaum P, Horke A. Bovine Jugular Veins versus Homografts in the Pulmonary Position: An Analysis across Two Centers and 711 Patients-Conventional Comparisons and Time Status Graphs as a New Approach. Thorac Cardiovasc Surg 2015; 64:25-35. [PMID: 26322831 DOI: 10.1055/s-0035-1554962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Various diseases and diversity in implantation ages, together with evolving diagnostic and therapeutic options, hinder comparative evaluations of long-term outcomes for valved conduits used for reconstruction of the right ventricular outflow tract (RVOT). We combined two common evaluation methods to optimally use information obtained by pooling the raw data from two high volume centers, each with very regular follow-up procedures, with the aim of analyzing durability differences between conventional homografts and bovine jugular veins. PATIENTS AND METHODS In the period 1985 to 2012, a total of 444 bovine jugular veins and 267 homografts were implanted, and 6,738 postoperative examinations took place. Evaluations included age-stratified Kaplan-Meier analyses, Cox regression models, and time status graphs, the third showing age-group stratified, time-related frequencies of intact, insufficient, stenotic, both insufficient and stenotic, and postinterventional conduits below the freedom from explantation curve. They take into account interventions, explantations, and the nonterminal character of echocardiographic findings. RESULTS The durability of intact bovine jugular veins in children and young adults is not inferior to that of homografts. Averaged over the first 12 years after implantation, the age groups < 25 years in fact showed advantages for bovine jugular vein recipients. The average fraction of patients younger than 25 years whose conduits were not explanted, postinterventional, stenotic, insufficient, or stenotic and insufficient was at least 10% higher in recipients of bovine jugular veins than in homograft recipients. CONCLUSION According to the time status graphs, the use of bovine jugular veins for RVOT in patients younger than 25 years appears to lead to superior results when compared with cryopreserved homografts.
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Affiliation(s)
- Eugen Sandica
- Clinic of Surgery for Congenital Heart Defects, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany
| | - Dietmar Boethig
- Clinic for Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Ute Blanz
- Clinic of Surgery for Congenital Heart Defects, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany
| | - Rainer Goerg
- Clinic for Pediatric Cardiology and Congenital Heart, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany
| | - Nikolaus Andreas Haas
- Clinic for Pediatric Cardiology and Congenital Heart, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany
| | - Kai Thorsten Laser
- Clinic for Pediatric Cardiology and Congenital Heart, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany
| | - Deniz Kececioglu
- Clinic for Pediatric Cardiology and Congenital Heart, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany
| | - Harald Bertram
- Clinic for Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Clinic for Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Philipp Beerbaum
- Clinic for Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Clinic for Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Happel CM, Laser KT, Sigler M, Kececioglu D, Sandica E, Haas NA. Single center experience: Implantation failures, early, and late complications after implantation of a partially biodegradable ASD/PFO-device (BioStar®). Catheter Cardiovasc Interv 2015; 85:990-7. [DOI: 10.1002/ccd.25783] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 12/06/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Christoph M. Happel
- Department for Congenital Heart Defects; Heart and Diabetes Centre North Rhine Westphalia; Ruhr University Bochum; Bad Oeynhausen North Rhine Westphalia Germany
| | - Kai Thorsten Laser
- Department for Congenital Heart Defects; Heart and Diabetes Centre North Rhine Westphalia; Ruhr University Bochum; Bad Oeynhausen North Rhine Westphalia Germany
| | - Matthias Sigler
- Department for Pediatric Cardiology; University Hospital Göttingen; Göttingen Lower Saxony Germany
| | - Deniz Kececioglu
- Department for Congenital Heart Defects; Heart and Diabetes Centre North Rhine Westphalia; Ruhr University Bochum; Bad Oeynhausen North Rhine Westphalia Germany
| | - Eugen Sandica
- Department for Surgery of Congenital Heart Defects; Heart and Diabetes Centre North Rhine Westphalia; Ruhr University Bochum; Bad Oeynhausen North Rhine Westphalia Germany
| | - Nikolaus A. Haas
- Department for Congenital Heart Defects; Heart and Diabetes Centre North Rhine Westphalia; Ruhr University Bochum; Bad Oeynhausen North Rhine Westphalia Germany
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Griselli M, de Rita F, Haynes S, Sandica E, Karimova A, Jurrmann N, Brandes K, Menon AK. 114-I * CLOSING THE GAP: FIRST RESULTS OF THE NEW 15-ML EXCOR PUMP FOR CHILDREN. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sandica E, Blanz U, Ben Mime L, Schultz-Kaizler U, Kirchner G, Knyphausen EZ, Lauenroth V, Morshuis M. 280 * LONG-TERM MECHANICAL CIRCULATORY SUPPORT IN PAEDIATRIC PATIENTS: THE BAD OEYNHAUSEN EXPERIENCE. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Haas NA, Happel CM, Jategaonkar S, Moysich A, Hanslik A, Kececioglu D, Sandica E, Laser KT. Compression, distortion and dislodgement of large caliber stents in congenital heart defects caused by cardiopulmonary resuscitation: a case series and review of the literature. Clin Res Cardiol 2014; 103:719-25. [PMID: 24700361 DOI: 10.1007/s00392-014-0706-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/24/2014] [Indexed: 02/07/2023]
Abstract
Stenting of vascular, extracardiac or lately intracardiac stenosis has become an established interventional treatment for a variety of problems in congenital or acquired heart disease. Most stent procedures are completed successfully and the long-term outcome is favorable in the majority of cases. Stent collapse or deformation is a well recognized entity in peripheral stents and can be attributed to insufficient radial force; it can also be attributed to excessive external forces, like deformation of stents in the right ventricular outflow tract, where external compression is combined with continuous movement caused by the beating heart. The protection of the thoracic cage may prove to be insufficient in extraordinary circumstances, such as chest compression in trauma or cardiopulmonary resuscitation (CPR). In this case series, we describe three patients in whom large endovascular stents were placed to treat significant stenosis of the aorta, the aortic arch or the venous system of the inferior vena cava close to the atrium. In all patients, CPR was necessary during their clinical course for various reasons; after adequate CPR, including appropriate chest compression all patients survived the initial resuscitation phase. Clinical, echocardiographic as well as radiologic re-evaluation after resuscitation revealed significant stent distortion, compression, displacement or additional vascular injury. The possibility of mechanical deformation of large endovascular stents needs to be considered and recognized when performing CPR; if CPR is successful, immediate re-evaluation of the implanted stents--if possible by biplane fluoroscopy--seems mandatory.
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Affiliation(s)
- Nikolaus A Haas
- Department of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany,
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Horke A, Hemmer W, Sandica E, Rüffer A, Cesnjevar R, Ciubotaru A, Boethig D. The RVOT conduit registry: Freedom from explantation of various conduit types. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Degener F, Haas N, Laser K, Blanz U, Kececioglu D, Sandica E. Case Report: Verschluss der Aortenklappe mittels Muscular VSD Occluder bei einem Patienten mit BIVAD und schwerer sekundärer Aorteninsuffizienz (AI). Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Haas N, Laser K, Fischer M, Degener F, Hertwig C, Fröhle M, Kececioglu D, Sandica E. Behandlung eines großen Aortenaneurysmas bei einer 13-Jährigen mit dem Cardiatis Multilayer Flow Modulator. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sandica E, Blanz U, Goerg R, Haas N, Bertram H, Breymann T, Boethig D, Sarikouch S, Beerbaum P, Horke A. Comparing Bovine Jugular Veins to Homografts in Pulmonary Position: 711 Patients, 2 Centers, Various Treatment Schemes, 27 Implantation Years, 3,092 Observation Years. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Haas N, Habash S, Laser K, Kececioglu D, Sandica E. Problematische Langzeiterfahrung mit teilweise bioresorbierbaren Vorhofseptumdefekt-Occludern (BioStar). Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Degener F, Haas N, Hertwig C, Laser K, Sandica E, Kececioglu D. Direkte intrapulmonale Injektion von Iloprost zur Testung der pulmonalen Vasoreagibilität. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Haas N, Laser K, Habash S, Fröhle M, Degener F, Kececioglu D, Sandica E. Was passiert mit implantierten großlumigen Stents im Rahmen einer Reanimation? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Koster A, Zittermann A, Sandica E. Transfusions and morbidity after surgery of congenital heart disease: pure statistics or time for a paradigm shift? J Thorac Cardiovasc Surg 2013; 145:1679. [PMID: 23679968 DOI: 10.1016/j.jtcvs.2013.01.046] [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] [Received: 12/27/2012] [Accepted: 01/11/2013] [Indexed: 10/26/2022]
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