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de Groot EM, Kingma BF, Goense L, van der Kaaij NP, Meijer RCA, Ramjankhan FZ, Schellekens PAA, Braithwaite SA, Marsman M, van der Heijden JJ, Ruurda JP, van Hillegersberg R. Surgical treatment of esophago-tracheobronchial fistulas after esophagectomy. Dis Esophagus 2024; 37:doad054. [PMID: 37592909 PMCID: PMC10762505 DOI: 10.1093/dote/doad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 08/19/2023]
Abstract
The aim of this study was to evaluate the surgical treatment of esophago-tracheobronchial fistulas (ETBFs) that occurred after esophagectomy with gastric conduit reconstruction in a tertiary referral center for esophageal surgery. All patients who underwent surgical repair for an ETBF after esophagectomy with gastric conduit reconstruction were included in a tertiary referral center. The primary outcome was successful recovery after surgical treatment for ETBF, defined as a patent airway at 90 days after the surgical fistula repair. Secondary outcomes were details on the clinical presentation, diagnostics, and postoperative course after fistula repair. Between 2007 and 2022, 14 patients who underwent surgical repair for an ETBF were included. Out of 14 patients, 9 had undergone esophagectomy with cervical anastomosis and 5 esophagectomy with intrathoracic anastomosis after which 13 patients had developed anastomotic leakage. Surgical treatment consisted of thoracotomy to cover the defect with a pericardial patch and intercostal flap in 11 patients, a patch without interposition of healthy tissue in 1 patient, and fistula repair via cervical incision with only a pectoral muscle flap in 2 patients. After surgical treatment, 12 patients recovered (86%). Mortality occurred in two patients (14%) due to multiple organ failure. This study evaluated the techniques and outcomes of surgical repair of ETBFs following esophagectomy with gastric conduit reconstruction in 14 patients. Treatment was successful in 12 patients (86%) and generally consisted of thoracotomy and coverage of the defect with a bovine pericardial patch followed by interposition with an intercostal muscle.
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Affiliation(s)
- E M de Groot
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B F Kingma
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N P van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R C A Meijer
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P A A Schellekens
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S A Braithwaite
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Marsman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J van der Heijden
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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de Jonge N, Damman K, Ramjankhan FZ, van der Kaaij NP, van den Broek SAJ, Erasmus ME, Kuijpers M, Manintveld O, Bekkers JA, Constantinescu AC, Brugts JJ, Oerlemans MIF, van Laake LW, Caliskan K. Listing criteria for heart transplantation in the Netherlands. Neth Heart J 2021; 29:611-622. [PMID: 34524619 PMCID: PMC8630329 DOI: 10.1007/s12471-021-01627-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/01/2022] Open
Abstract
The updated listing criteria for heart transplantation are presented on behalf of the three heart transplant centres in the Netherlands. Given the shortage of donor hearts, selection of those patients who may expect to have the greatest benefit from a scarce societal resource in terms of life expectancy and quality of life is inevitable. The indication for heart transplantation includes end-stage heart disease not remediable by more conservative measures, accompanied by severe physical limitation while on optimal medical therapy, including ICD/CRT‑D. Assessment of this condition requires cardiopulmonary stress testing, prognostic stratification and invasive haemodynamic measurements. Timely referral to a tertiary centre is essential for an optimal outcome. Chronic mechanical circulatory support is being used more and more as an alternative to heart transplantation and to bridge the progressively longer waiting time for heart transplantation and, thus, has become an important treatment option for patients with advanced heart failure.
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Affiliation(s)
- N de Jonge
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - K Damman
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - N P van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S A J van den Broek
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - M E Erasmus
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - M Kuijpers
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - O Manintveld
- Department of Cardiology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J A Bekkers
- Department of Cardiothoracic Surgery, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A C Constantinescu
- Department of Cardiology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J J Brugts
- Department of Cardiology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M I F Oerlemans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L W van Laake
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - K Caliskan
- Department of Cardiology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
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Felix SEA, Ramjankhan FZ, Buijsrogge MP, Jacob KA, Asselbergs FW, Oerlemans MIF, Kirkels JH, van Laake LW, Oppelaar AMC, Suyker WJL, de Jonge N. Outcome of mechanical circulatory support at the University Medical Centre Utrecht. Neth Heart J 2020; 28:210-218. [PMID: 32096095 PMCID: PMC7113343 DOI: 10.1007/s12471-020-01375-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The prevalence of heart failure (HF) is increasing substantially and, despite improvements in medical therapy, HF still carries a poor prognosis. Mechanical circulatory support (MCS) by a continuous-flow left ventricular assist device (cf-LVAD) improves survival and quality of life in selected patients. This holds especially for the short-term outcome, but experience regarding long-term outcome is growing as the waiting time for heart transplantation is increasing due to the shortage of donor hearts. Here we present our results from the University Medical Centre Utrecht. Methods Data of all patients with a cf-LVAD implant between March 2006 and January 2018 were collected. The primary outcome was survival. Secondary outcomes included adverse events defined according to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) definitions, described per patient year. Results A total of 268 patients (69% male, mean age 50 ± 13 years) received a cf-LVAD. After a median follow-up of 542 (interquartile range 205–1044) days, heart transplantation had been performed in 82 (31%) patients, the cf-LVAD had been explanted in 8 (3%) and 71 (26%) had died. Survival at 1, 3 and 5 years was 83%, 72% and 57%, respectively, with heart transplantation, cf-LVAD explantation or death as the end-point. Death was most often caused by neurological complications (31%) or infection (20%). Major bleeding occurred 0.51 times and stroke 0.15 times per patient year. Conclusion Not only short-term results but also 5‑year survival after cf-LVAD support demonstrate that MCS is a promising therapy as an extended bridge to heart transplantation. However, the incidence of several major complications still has to be addressed. Electronic supplementary material The online version of this article (10.1007/s12471-020-01375-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S E A Felix
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands.
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - M P Buijsrogge
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - K A Jacob
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - M I F Oerlemans
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J H Kirkels
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - L W van Laake
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A M C Oppelaar
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - W J L Suyker
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - N de Jonge
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
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Meuwese CL, Ramjankhan FZ, Kraaijeveld AO, Donker DW. Venoarterial extracorporeal membrane oxygenation in elective high-risk percutaneous coronary intervention: a viable option? Neth Heart J 2020; 28:136-138. [PMID: 32040720 PMCID: PMC7052087 DOI: 10.1007/s12471-020-01372-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- C L Meuwese
- Department of Intensive Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - D W Donker
- Department of Intensive Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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Jansen R, Wind AM, Cramer MJ, Nijhoff F, Agostoni P, Ramjankhan FZ, Suyker WJ, Stella PR, Chamuleau SAJ. Evaluation of mitral regurgitation by an integrated 2D echocardiographic approach in patients undergoing transcatheter aortic valve replacement. Int J Cardiovasc Imaging 2018. [PMID: 29524077 DOI: 10.1007/s10554-018-1328-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate mitral regurgitation (MR) severity in patients undergoing transcatheter aortic valve replacement (TAVR) by standardized assessment of two-dimensional (2D) transthoracic echocardiography (TTE) and 1-year echocardiographic and clinical outcomes. Pre- and post-procedural TTE's of patients undergoing TAVR between 2008 and 2014 were analyzed. MR was graded according to current guidelines with a systematic and integrated approach. Longitudinal echocardiographic and clinical results were analyzed. Regression analysis was performed for change in MR grade at follow-up, using pre-determined variables and confounders. Pre- and post-procedural TTE were available in 213 subjects. Significant MR was seen in 22% at baseline and 15% at follow-up; MR grade ≥ 3 in < 10%. Severity did not change in 61%, and decreased in 20% of the patients. Overall, the prevalence of MR grades pre- and post TAVR was not significantly different, nor influenced by MR etiology or TAVR prosthesis type. However, higher MR grades and pacemaker absence at baseline, were independently correlated to more improvement of MR after TAVR. Regarding clinical outcomes, NYHA class improved in two-thirds of the patients, irrespective of the baseline MR grade. Overall survival was not significantly different amongst MR grades post-TAVR. MR grading using an systematic 2D echocardiographic approach in patients undergoing TAVR is feasible in clinical practice. Our data revealed a relatively frequent prevalence of significant MR (although grade ≥ 3 was scarce), overall no change in the MR grade at 1 year follow-up, improvement of functional NYHA class, and no significant differences in long-term survival amongst the post-TAVR MR grades.
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Affiliation(s)
- R Jansen
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - A M Wind
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M J Cramer
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - F Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P Agostoni
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W J Suyker
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Kuindersma M, Terpstra WF, Ramjankhan FZ, van Gorselen EOF. A double barrelled myxoma. Eur Heart J 2015; 36:2652. [PMID: 26141396 DOI: 10.1093/eurheartj/ehv285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Kuindersma
- Department of Cardiology, Slingeland Hospital, Kruisbergseweg 25, PO Box 169, Doetinchem 7000 AD, The Netherlands;
| | - W F Terpstra
- Department of Cardiology, Slingeland Hospital, Kruisbergseweg 25, PO Box 169, Doetinchem 7000 AD, The Netherlands
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, UMC Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - E O F van Gorselen
- Department of Cardiology, Slingeland Hospital, Kruisbergseweg 25, PO Box 169, Doetinchem 7000 AD, The Netherlands
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Tseng CCS, Chamuleau SAJ, De Jonge N, Ramjankhan FZ. Short-term mechanical support and pharmacotherapy, a new strategy in cardiogenic shock? Neth Heart J 2014; 22:174-5. [PMID: 24549485 PMCID: PMC3954936 DOI: 10.1007/s12471-014-0531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Felix SEA, Martina JR, Kirkels JH, Klöpping C, Nathoe H, Sukkel E, Hulstein N, Ramjankhan FZ, Doevendans PAFM, Lahpor JR, de Jonge N. Continuous-flow left ventricular assist device support in patients with advanced heart failure: points of interest for the daily management. Eur J Heart Fail 2012; 14:351-6. [PMID: 22308012 DOI: 10.1093/eurjhf/hfs012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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] [Indexed: 12/28/2022] Open
Abstract
Today, continuous-flow left ventricular assist devices (cf-LVADs) are implanted more often in patients with end-stage heart failure. Because of greater durability they can be implanted for an extended period of time. As a result of increased numbers of patients on cf-LVAD support, healthcare professionals should be aware of the potential complications inherent to this therapy. Both bleeding and thrombosis may occur, and also complications related either to the device itself or to the ensuing altered haemodynamics, valvular pathology, and rhythm disturbances such as ventricular tachycardias and fibrillation. Accurate clinical evaluation, together with an electrocardiogram and, if necessary, combined with an echocardiogram, is obligatory in these situations. This review summarizes common complications complemented by a few clinical cases.
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Affiliation(s)
- S E A Felix
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
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