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Neumann A, Serna-Higuita L, Detzel H, Popov AF, Krüger T, Vöhringer L, Schlensak C. Off-pump coronary artery bypass grafting for patients with severely reduced ventricular function-A justified strategy? J Card Surg 2021; 37:7-17. [PMID: 33547711 DOI: 10.1111/jocs.15259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Low ejection fraction (EF) has been identified as a main risk factor for perioperative complications and mortality after coronary artery bypass grafting (CABG). The purpose of this study was to compare the efficacy and early as well as midterm outcomes of off-pump CABG (OPCAB) and conventional CABG (ONCAB) surgery in patients with reduced EF. METHODS We performed a retrospective review of patient demographics, preoperative risk factors, operative and postoperative outcomes of patients with left ventricular EF (LV-EF) ≤35%, who underwent CABG at our institution between January 2015 and December 2017. Propensity score and multivariate logistic regression analysis were used to compare risk adjusted outcomes between groups. RESULTS Overall, 111 consecutive CABG-patients with LV-EF ≤ 35% underwent either ONCAB (46 patients, 41.4%) or OPCAB surgery (65 patients, 58.6%). There was no difference in early mortality (5% vs. 7.5%, p = .64) between groups. After propensity score matching, OPCAB-patients required significantly less re-sternotomies for bleeding (20% vs. 2.5%, p = .03) and consequently received significantly less blood transfusions (57.5% vs. 32.5%, p = .03). Fewer OPCAB-patients experienced low cardiac output syndrome (22.5% vs. 42.5%, p = .06) and suffered from postoperative delirium (22.5% vs. 42.5%, p = .06). There were no differences in completeness of revascularization between groups (median 1 (1.0-1.33; 1.0-1.33) OPCAB versus median 1 (1-1.33; 0.67-2) ONCAB, p = .95). Survival after 6 months, one year and three years was similar for ONCAB- and OPCAB-patients (ONCAB 92.3%, 89.4%, and 89.4% vs. OPCAB 89.8%, 85.7%, and 82.1%; p = .403). More ONCAB-patients needed a coronary re-intervention during follow-up (8.6% vs. 2.3%, p = .402). CONCLUSION OPCAB-surgery is a safe and effective option for patients with reduced EF. Furthermore, it does not come at the expense of less complete revascularization or increased coronary re-intervention during early follow-up.
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Affiliation(s)
- Anneke Neumann
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.,Department of Vascular and Endovascular Surgery, Hospital Ludwigsburg, Ludwigsburg, Germany
| | - Lina Serna-Higuita
- Institut for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Hendrik Detzel
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Aron-Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Tobias Krüger
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Luise Vöhringer
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
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Granja T, Magunia H, Schüssel P, Fischer C, Prüfer T, Schibilsky D, Serna-Higuita L, Wendel HP, Schlensak C, Häberle H, Rosenberger P, Straub A. Left ventricular assist device implantation causes platelet dysfunction and proinflammatory platelet-neutrophil interaction. Platelets 2020; 33:132-140. [PMID: 33347335 DOI: 10.1080/09537104.2020.1859101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Blood flow through left ventricular assist devices (LVAD) may induce activation and dysfunction of platelets. Dysfunctional platelets cause coagulation disturbances and form platelet-neutrophil conjugates (PNC), which contribute to inflammatory tissue damage. This prospective observational cohort study investigated patients, who underwent implantation of a LVAD (either HeartMate II (HM II) (n = 7) or HeartMate 3 (HM 3) (n = 6)) and as control patients undergoing coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) (n = 10). We performed platelet and leukocyte flow cytometry, analysis of platelet activation markers, and platelet aggregometry. Platelet CD42b expression was reduced at baseline and perioperatively in HM II/3 compared to CABG/AVR patients. After surgery the platelet activation marker β-thromboglobulin and platelet microparticles increased in all groups while platelet aggregation decreased. Platelet aggregation was more significantly impaired in LVAD compared to CABG/AVR patients. PNC were higher in HM II compared to HM 3 patients. We conclude that LVAD implantation is associated with platelet dysfunction and proinflammatory platelet-leukocyte binding. These changes are less pronounced in patients treated with the newer generation LVAD HM 3. Future research should identify device-specific LVAD features, which are associated with the least amount of platelet activation to further improve LVAD therapy.
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Affiliation(s)
- Tiago Granja
- Dept. of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
| | - Harry Magunia
- Dept. of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
| | - Patricia Schüssel
- Dept. of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany.,Dept. of Urology, Caritas Hospital, Bad Mergentheim, Germany
| | - Claudius Fischer
- Dept. of Anesthesiology and Intensive Care Medicine, MediClin Herzzentrum, Lahr/Baden, Germany
| | - Thomas Prüfer
- Dept. of Anesthesiology and Intensive Care Medicine, Klinikum Bayreuth, Germany
| | - David Schibilsky
- University Heart Center Freiburg / Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany.,Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Germany
| | - Lina Serna-Higuita
- Dept. of Thoracic, Cardiac and Vascular Surgery, University Hospital, Tübingen Germany
| | - Hans Peter Wendel
- Dept. of Anesthesiology, Intensive Care, Emergency, and Pain Medicine, St. Elisabethen Klinikum, Ravensburg, Germany
| | - Christian Schlensak
- Dept. of Anesthesiology, Intensive Care, Emergency, and Pain Medicine, St. Elisabethen Klinikum, Ravensburg, Germany
| | - Helene Häberle
- Dept. of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
| | - Peter Rosenberger
- Dept. of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
| | - Andreas Straub
- Dept. of Anesthesiology, Intensive Care, Emergency, and Pain Medicine, St. Elisabethen Klinikum, Ravensburg, Germany
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Grimm AS, Schubert C, Grimm A, Stahl JH, Küpper H, Horber V, Kegele J, Willikens S, Wittlinger J, Serna-Higuita L, Winter N, Groeschel S. Normative Observational Nerve Ultrasound Values in School-Age Children and Adolescents and Their Application to Hereditary Neuropathies. Front Neurol 2020; 11:303. [PMID: 32411079 PMCID: PMC7198742 DOI: 10.3389/fneur.2020.00303] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/30/2020] [Indexed: 12/31/2022] Open
Abstract
Backgrounds: We have aimed to establish nerve ultrasound reference data in 8 to 17-year-old children and adolescents and to compare those data to younger children, adults, and age-matched children with polyneuropathies. Methods: High-resolution ultrasounds of the nerves were performed in 117 healthy children and adolescents at 20 predefined landmarks in the neck and the extremities of both sides. Mean values, side-to-side differences and intraneural ratios, as well as upper limits have been calculated. In a second step, a comparison between 25 children and adolescents of the same age range with proven hereditary and acquired neuropathies and lysosomal storage diseases has been carried out. Results: Nerve growth correlates significantly with age and reaches adult values at the age of around 15 years. The influence of body mass index and gender is negligible at most segments. By the use of age-specific upper limits, nerve enlargement could be seen in distinct types of neuropathies, particularly in demyelinating hereditary and inflammatory types, which is comparable to findings in adults, but also in rare lysosomal storage diseases. Conclusion: Nerve size correlates with age during childhood and reaches a climax in younger adults. Age-matched reference data are inevitable to differ between hypertrophic and non-hypertrophic nerve damage, e.g., in neuropathies.
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Affiliation(s)
- Anna-Sophie Grimm
- Department of Pediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Charlotte Schubert
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Alexander Grimm
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Jan-Hendrik Stahl
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,Center of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Hanna Küpper
- Department of Pediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Veronka Horber
- Department of Pediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Josua Kegele
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,Center of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,University Hospital Tübingen, Neurology, Tübingen, Germany
| | - Sophia Willikens
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,University Hospital Tübingen, Neurology, Tübingen, Germany
| | | | - Lina Serna-Higuita
- Department of Clinical Epidemiology and Applied Biostatistics, Tübingen University, Tübingen, Germany
| | - Natalie Winter
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,Center of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Samuel Groeschel
- Department of Pediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
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Vélez-Echeverri C, Suárez M, Serna-Higuita L, Serrano-Gayubo AK, Vanegas-Ruiz JJ, Hidalgo JM, Arias LF, Eraso RM. Middle aortic syndrome as the cause of renovascular hypertension in a 3-year-old girl: difficulties in the differential diagnosis. Nefrologia 2013; 33:281-283. [PMID: 23511769 DOI: 10.3265/nefrologia.pre2012.oct.11769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 06/01/2023] Open
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