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Sapien 'valve-in-valve' implantation and valve leaflet resection for treating endocarditis of a bioprosthetic mitral valve: a case report. Eur Heart J Case Rep 2024; 8:ytae078. [PMID: 38405192 PMCID: PMC10894001 DOI: 10.1093/ehjcr/ytae078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/17/2024] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
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2
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"UFO procedure" for massive aortic and mitral annular calcification involving left atrial and ventricular myocardium: a potential radical solution. J Cardiothorac Surg 2023; 18:185. [PMID: 37231497 DOI: 10.1186/s13019-023-02267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/04/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The "UFO procedure" was initially developed as a surgical option to enlarge the aortic annulus in patients requiring valve replacement. This technique can be employed to treat extensive endocarditis located in the intervalvular fibrous body (IVFB). One of the indications for a "UFO procedure" is massive aortic and mitral valve calcification. It is a challenging surgical procedure with a high risk of intraoperative complications. We present a 76-year-old male patient with massive aortic and mitral valve calcification involving the left atrium, the left ventricle and the left ventricular outflow tract. Both valves exhibited severe stenosis and moderate to severe regurgitation. The left ventricle was hypertrophic and the left ventricular ejection fraction was > 55%. The patient was prediagnosed with persistent atrial fibrillation. The risk of death following heart surgery (EuroSCORE II) was calculated as 9.21%. We successfully performed a so-called "UFO procedure" including replacement of both valves without annular decalcification to avoid atrioventricular dehiscence. We enlarged the IVFB and replaced the non-coronary sinus of Valsalva with doubled bovine pericardium. The left ventricular outflow tract was decalcified. The patient was transferred to a local hospital on the 13th postoperative day. CONCLUSION Successful surgical treatment to this extent was demonstrated for the first time. Due to the high perioperative mortality, the surgical treatment of patients with this constellation would be refused in most cases. In our patient, the preoperative imaging showed extreme calcification of both valves and the surrounding myocardium. Excellent preoperative planning and a highly experienced surgical team is necessary.
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3
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UFO procedure: Two small surgical details. J Card Surg 2022; 37:3448. [PMID: 35819132 DOI: 10.1111/jocs.16763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
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4
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Subtotal obstruction of the left coronary ostium by chronic neo-intimal ingrowth. Eur Heart J 2022; 43:2816. [PMID: 35673900 DOI: 10.1093/eurheartj/ehac195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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5
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OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 34:919-920. [PMID: 35134948 PMCID: PMC9070524 DOI: 10.1093/icvts/ivac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
Ischaemic ventricular septal defect is a serious complication of acute myocardial infarction with poor outcome. We present the ‘beating-heart butterfly’ technique to close the ventricular septal defect with a double-layered pericardial patch sewn to the intact septum under beating-heart cardiopulmonary bypass in 4 highest-risk patients. This technique combined with a liberal postoperative mechanical circulatory support and open-chest treatment allowed excellent results with 12 months of survival in all patients.
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6
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Resolution of severe secondary mitral valve regurgitation following aortic valve replacement in infective endocarditis. SAGE Open Med Case Rep 2021; 9:2050313X211034377. [PMID: 34377480 PMCID: PMC8320548 DOI: 10.1177/2050313x211034377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
We present the case of a patient with infective endocarditis anesthetized for replacement of severely regurgitant aortic valve. Intraoperative transesophageal echocardiography revealed a new diagnosis of severe secondary mitral regurgitation. After aortic valve replacement and tricuspid valve repair, severe mitral regurgitation resolved rapidly without any intervention. In multivalvular disease, instant spontaneous resolution of secondary mitral regurgitation is possible after surgical correction of an aortic regurgitation causing left ventricular volume overload.
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7
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Cardiac computed tomography for therapy targeting in surgical repair of anteroapical left ventricular aneurysms: assessment of aneurysm volume and of anticipated residual left ventricular volume. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Surgical ventricular repair (SVR) is an established treatment option in patients with heart failure (HF) due to left ventricular (LV) aneurysms, whereby LV volume reduction is the principal therapeutic target. Precise planning therefore is essential for postoperative improvement of HF symptoms.
Purpose
In this study we evaluated the potential of cardiac computed tomography (CCT) to estimate the aneurysm volume and to predict the achievable residual LV volume.
Methods
205 patients (11/2005-01/2016, m:w = 151:54, median 63.4 years; mean NYHA class 3.03) with anteroapical LV aneurysm underwent SVR combined with coronary artery bypass grafting (77%), mitral valve repair/replacement (19%), and LV thrombectomy (19%). CCT was performed before and 7 days after surgery. Volumetric assessment was made using dedicated software (syngo.via Cardiac Function, Siemens AG). Preoperative CCT data of 48 consecutive patients were analyzed and then matched with effectively achieved postoperative volumes. To separate the aneurysm volume in the systole and diastole a plane determined by three landmarks on borders of scared to intact LV myocardium (antero-septal, lateral and inferior) was used. In this way ensued the retrospective estimation of the aneurysm volume (AnV/AnVI) and anticipated LV end diastolic and end systolic volume (LVEDVI, LVESVI).
Results
Mean diastolic and systolic estimated AnV were 92 ± 56.6 ml and 83.5 ± 61.6 ml respectively. Relation of AnV to LVEDV and to LVESV was 29.2% and 38.2%, correspondingly. There was significant correlation between anticipated and effectively achieved LVEDV and LVESV (r = 0.87 and r = 0.88, respectively, p < 0.0001), and their indexed values (r = 0.83 and r = 0.83, respectively, p < 0.0001). Anticipated LVEDVI was only 10.3 ± 22.5 ml/m2 greater than achieved LVEDVI (p = 0.003), and anticipated LVESVI was only 2.4 ± 20.3 ml/m2 greater than achieved LVESVI (p = 0.433).
Conclusions
Estimation of aneurysm volume and anticipated postoperative LV volume allows to predict if the therapeutic targets can be successfully achieved in individual patients. Based on the CCT assessment we propose an approach for surgical planning in anterior LV aneurysms.
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The effect of transcatheter aortic valve implantation approaches on mortality. Catheter Cardiovasc Interv 2021; 97:1462-1469. [PMID: 33443813 DOI: 10.1002/ccd.29456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/09/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) approaches on mortality and identify effect modifiers and predictors for mortality. BACKGROUND Alternative access routes to transfemoral (TF) TAVI include the surgical intra-thoracic direct-aortic (DA) and transapical (TA) approach. TA TAVI has been associated with a higher mortality rate. We hypothesized that this is related to effect modifiers, in particular the left ventricular ejection fraction (LVEF). METHODS This multicentre study derived its data from prospective registries. To adjust for confounders, we used propensity-score based, stabilized inverse probability weighted Cox regression models. RESULTS In total, 5,910 patients underwent TAVI via TF (N = 4,072), DA (N = 524), and TA (N = 1,314) access. Compared to TF, 30-day mortality was increased among DA (HR 1.87, 95%CI 1.26-2.78, p = .002) and TA (HR 3.34, 95%CI 2.28-4.89, p < .001) cases. Compared to TF, 5-year mortality was increased among TA cases (HR 1.50, 95%CI 1.24-1.83, p < .001). None of the variables showed a significant interaction between the approaches and mortality. An impaired LVEF (≤35%) increased mortality in all approaches. CONCLUSIONS The surgical intra-thoracic TA and DA TAVI are both associated with a higher 30-day mortality than TF TAVI. TA TAVI is associated with a higher 5-year mortality than TF TAVI. The DA approach may therefore have some advantages over the TA approach when TF access is not feasible.
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9
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Annular Rupture During TAVR: Despite It, Dr. Alain Cribier Should Receive a Nobel Prize. JACC Cardiovasc Interv 2020; 13:1800-1802. [PMID: 32763072 DOI: 10.1016/j.jcin.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 10/23/2022]
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10
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Extensive cutaneous necrosis in infective endocarditis: do not forget rare causes. Eur Heart J 2020; 41:2337. [PMID: 31872234 DOI: 10.1093/eurheartj/ehz910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/03/2019] [Indexed: 11/14/2022] Open
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11
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Repair of Anteroapical Left Ventricular Aneurysms Guided by Use of Cardiac Computed Tomography: Assessment of Aneurysm Volume and of Anticipated Residual Left Ventricular Volume. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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13
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Transcatheter Treatment of Tricuspid Valve Disease: An Unmet Need? The Surgical Point of View. Front Cardiovasc Med 2018; 5:98. [PMID: 30083537 PMCID: PMC6064939 DOI: 10.3389/fcvm.2018.00098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/02/2018] [Indexed: 11/13/2022] Open
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14
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Zystische Echinokokkose – eine interdisziplinäre Herausforderung. Pneumologie 2018. [DOI: 10.1055/s-0037-1619389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Transcatheter Aortic Valve Replacement for Left Ventricular Assist Device-Induced Aortic Insufficiency. J Cardiothorac Vasc Anesth 2018; 32:1982-1990. [PMID: 29699845 DOI: 10.1053/j.jvca.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Indexed: 11/11/2022]
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16
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Survival Determinants and Improvement of Heart Failure Symptoms after Surgical Repair of Anteroapical Left Ventricular Aneurysms Guided with Multislice Computed Tomography. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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Beating heart mitral valve surgery: results in 120 consecutive patients considered unsuitable for conventional mitral valve surgery†. Interact Cardiovasc Thorac Surg 2017; 25:541-547. [DOI: 10.1093/icvts/ivx139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 03/04/2017] [Indexed: 11/15/2022] Open
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18
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Reverse Remodeling of Mitral Valve Apparatus after Surgical Repair of Acquired Left Ventricular Aneurysms of Posterior versus Anterior Localization Assessed with Multislice Computed Tomography. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Quality of Life After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:2541-2554. [DOI: 10.1016/j.jcin.2016.09.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
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20
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Transcatheter Aortic Valve Implantation in Nonagenarians. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Ruptured Mycotic Extracranial Carotid Aneurysm Treated by Excision, PTFE Graft Interposition, and Local Antibiotic Application—A Case Report. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449202600512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A very rare case of ruptured mycotic extracranial carotid aneurysm caused by Streptococcus pneumoniae is described. An eighty-one-year-old man with a painful swelling of the right side of the neck was operated upon. There was no available vein for graft interposition and no retrograde flow in the internal carotid artery. The patient was successfully treated by resection of the aneurysm, 6 mm ringed polytetrafluoro-ethylene prosthesis interposition, and preoperative and postoperative antibiotic therapy combined with local antibiotic application. Seven months after the operation the patient remains free from complications.
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22
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Abstract
Extracorporeal membrane oxygenation (ECMO) is a cumbersome procedure. Alternatively, mechanical lung assist can be realized with an intravascular gas exchanger (IVOX). To assess the degree of initial anticoagulation required during intravascular lung assist, we evaluated two regimens of systemic heparinization in 10 bovine experiments. The animals were randomly assigned to two groups with either full systemic heparinization (heparin loading dose 300 IU/kg bodyweight; activated coagulation time (ACT) > 480 s) or low systemic heparinization (heparin loading dose 100 IU/kg bodyweight; ACT > 180 s). The surface heparinized intravascular gas exchanger was placed in the caval axis under fluoroscopic control, and a standard battery of blood samples was drawn before and at regular intervals during the procedure. After six hours of intravascular lung assist the device was explanted, drained, weighed, and carefully analysed. Preassist haematocrit was 25 ± 5% for full versus 24 ± 7% for low (NS) as compared with 23 ± 8% for full versus 26 ± 3% for low (NS) postassist. Platelet levels were 100 ± 25 for full versus 100 ± 21 % for low (NS) preassist as compared with 64 ± 22% for full versus 78 ± 22% for low (NS) postassist. Mean ACT was 157 ± 12 s for full versus 158 ± 18 for low (NS) preassist as compared with 800 ± 244 s versus 219 ± 25 for low (p < 0.05) postassist. Thrombin time was 20 ± 2 s for full versus 23 ± 2 s for low (NS) as compared with > 200 s for both groups after assist. Relative fibrinopeptide A levels were 7.3 ± 1.1 ng/ml for full versus 6.3 ± 1.6 ng/ml for low (NS) preassist as compared with 4.7 ± 4.1 ng/ml for full versus 5.8 ± 0.9 ng/ml for low (NS) postassist. CO2 transfer was 40 ± 10 ml/min for full versus 36 ± 10 ml/min for low (NS) at the begining as compared with 45 ± 25 ml/min for full versus 46 ± 15 for low (NS) at the end. Weight increase due to device deposits (clots) was 14 ± 11 g for full versus 13 ± 10 g for low systemic heparinization (NS). Intravascular lung assist with low versus full systemic heparinization appeared to result in similar activation of the coagulation system, device deposits and gas transfer rates. Considering our clinical experience we can say that application of the device with reduced systemic heparinization is useful in selected patients.
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Multislice computed tomography-guided surgical repair of acquired posterior left ventricular aneurysms: demonstration of mitral valve and left ventricular reverse remodelling. Interact Cardiovasc Thorac Surg 2016; 23:383-90. [PMID: 27222112 DOI: 10.1093/icvts/ivw137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 04/11/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Involvement of the mitral valve (MV) apparatus represents a challenge in surgical ventricular repair (SVR) of posterior left ventricular (LV) aneurysms. This study sought to investigate whether multislice computed tomography (MSCT) assessment can be used to optimize the surgical procedure for posterior LV aneurysms. METHODS Thirty patients (m : w = 24 : 6, age 38-78, median 66 years; mean New York Heart Association class 2.98) with posterior LV aneurysm were operated upon. MSCT was performed in 24 patients before and after surgery. End-diastolic and end-systolic volumes of LV and aneurysm were indexed to body surface area (LVEDVI/LVESVI, AEDVI/AESVI). The MV apparatus was characterized by coaptation distance (CD), tenting area (TA), MV closure angle (MVCA), MV annulus area (MVAA) and interpapillary muscle distance (IMD). RESULTS Thirty-day mortality was 10% and 5-year survival rate was 83%. After surgery, LVEDVI decreased from 151.2 ± 84.1 to 85.7 ± 28.3 ml/m(2) (P = 0.001) and LVESVI from 110.6 ± 88.8 to 50.2 ± 22.9 ml/m(2) (P = 0.001). LV ejection fraction increased from 31.5 ± 15.1 to 43.4 ± 9.9% (P = 0.001). Preoperative MSCT showed significantly higher values of MVAA, CD and TA in patients who needed MV repair or replacement. Postoperative reduction of mitral regurgitation in patients without MV surgery corresponded with significant reduction in intercommissural diameter, anteroposterior diameter, MVAA, TA, CD, MVCA and IMD. CONCLUSIONS MSCT represents an excellent diagnostic tool for the assessment of MV and LV geometry. MSCT-guided SVR of submitral LV aneurysms leads to excellent mid-term results. On the basis of the MSCT assessment, we propose an algorithm for surgical planning in posterior LV aneurysms.
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Beating Heart Mitral Valve Surgery: Results in 120 Consecutive Patients Considered Non-suitable Candidates for Conventional Mitral Valve Surgery. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Interventricular septum aneurysm: Two differently managed cases and association with bicuspid aortic valve. Int J Cardiol 2015; 201:438-40. [PMID: 26313862 DOI: 10.1016/j.ijcard.2015.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022]
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26
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Vent-induced prosthetic leaflet thrombosis treated by open-heart valve-in-valve implantation. Interact Cardiovasc Thorac Surg 2015; 21:389-90. [PMID: 26069339 DOI: 10.1093/icvts/ivv150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 05/05/2015] [Indexed: 11/14/2022] Open
Abstract
A patient required emergency mitral valve replacement and extracorporeal membrane oxygenation (ECMO) support for acute biventricular failure. The left ventricular (LV) vent inserted via the left upper pulmonary vein induced thrombotic immobilization of a prosthetic valve leaflet, with significant intra-prosthesis regurgitation after ECMO explantation. Therefore, the left atrium was opened on the beating heart during conventional extracorporeal circulation, all prosthesis leaflets were excised and a 29-mm expandable Edwards Sapien prosthesis was inserted within the scaffold of the original prosthesis under direct vision. This case illustrates the benefits and potential problems of LV venting on ECMO support, and a rapid and safe way of replacing the prosthesis leaflets in a critical situation.
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27
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Left apical aneurysm in a patient with severe aortic valve stenosis. Thorac Cardiovasc Surg Rep 2015; 3:9-12. [PMID: 25798350 PMCID: PMC4360685 DOI: 10.1055/s-0034-1374806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 02/27/2014] [Indexed: 11/16/2022] Open
Abstract
We report on a very rare case of left ventricular aneurysm in a 77-year-old patient with aortic valve stenosis and without coronary artery disease. The patient underwent conventional aortic valve replacement and left ventricular aneurysmectomy with an uneventful postoperative course. The cause of the left ventricular aneurysm was suspected to be a long history of aortic valve stenosis that led to severe intraventricular hypertension, subsequently asymmetric septum hypertrophy, and finally apical aneurysm.
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28
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3D Echocardiography versus 3D Reconstructive Computed Tomography Software for Optimal Sizing for TAVI. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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Transcatheter Aortic Valve Implantation in Nonagenarians. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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30
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Right Ventricular Recovery Induced by Temporary Right Ventricular Assist Device Support. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Annular Rupture During Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2015; 8:1-9. [DOI: 10.1016/j.jcin.2014.07.020] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/20/2014] [Accepted: 07/02/2014] [Indexed: 12/21/2022]
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32
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Concomitant surgery during ventricular assist device implantation. Ann Cardiothorac Surg 2014; 3:630-1. [PMID: 25512908 DOI: 10.3978/j.issn.2225-319x.2014.08.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/19/2014] [Indexed: 11/14/2022]
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33
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Anticoagulation assessment. Ann Cardiothorac Surg 2014; 3:538-40. [PMID: 25452917 DOI: 10.3978/j.issn.2225-319x.2014.08.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/19/2014] [Indexed: 11/14/2022]
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34
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Different surgical strategies for implantation of continuous-flow VADs-Experience from Deutsches Herzzentrum Berlin. Ann Cardiothorac Surg 2014; 3:472-4. [PMID: 25452906 DOI: 10.3978/j.issn.2225-319x.2014.09.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/25/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This manuscript summarizes our surgical experience with the implantation of recent continuous-flow left ventricular assist devices (LVADs), with special emphasis on the HeartWare HVAD pump. METHODS THE HEARTWARE HVAD IS, IN OUR EXPERIENCE CURRENTLY IMPLANTED IN FOUR DIFFERENT TECHNIQUES: (I) "Classical" LVAD implantation with heart-lung machine and median sternotomy; (II) "Minimally-invasive" implantation without sternotomy and without heart-lung machine; (III) "Lateral implantation" to the descending aorta; (IV) Using two continuous-flow LVADs for implantable biventricular support. RESULTS Five-hundred and four HeartWare HVADs have been implanted using the described techniques in our institution up to now. CONCLUSIONS The HeartWare HVAD is a versatile device. It has been found to be eminently suited to these four different modes of implantation.
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Transapical Aortic Valve Implantation: Predictors of Leakage and Impact On Survival: An Update. Ann Thorac Surg 2014; 98:1308-15. [DOI: 10.1016/j.athoracsur.2014.05.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/08/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
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36
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Transfemoral uncovered stent to treat iatrogenic type A dissection during transcatheter aortic valve implantation. Eur Heart J 2014; 36:187. [PMID: 25217441 DOI: 10.1093/eurheartj/ehu368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Transcatheter aortic valve implantation combined with elective coronary artery stenting: a simultaneous approach†. Eur J Cardiothorac Surg 2014; 47:1083-9. [PMID: 25217500 DOI: 10.1093/ejcts/ezu339] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 08/01/2014] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Many patients referred for transcatheter aortic valve implantation (TAVI) also require percutaneous coronary intervention (PCI). The aim of the study was to identify whether combined treatment of patients with aortic stenosis and coronary artery disease (CAD) with TAVI and PCI has comparable results to treatment of patients with no CAD or with CAD with non-significant lesions who receive only TAVI. METHODS Between April 2008 and August 2013, 730 consecutive patients underwent transapical TAVI at our institution. In our study population of 593 patients, 285 (48.1%) had no CAD and received TAVI only (Group I); 232 (39.1%) presented with CAD but no highly significant coronary artery lesion(s) and also received TAVI only (Group II), and 76 (12.8%) had CAD and highly significant coronary lesion(s) and underwent combined, single-staged TAVI and PCI (Group III). Three transapical TAVI patients who received PCI because of iatrogenic coronary artery obstruction during TAVI and 134 transapical TAVI patients with previous CABG were excluded from this study. RESULTS Group II showed a calculated mean SYNTAX score of 5.7 ± 7.4. However, Group III showed a statistically significantly higher mean SYNTAX score of 8.0 ± 5.7 than Group II (P < 0.001) before the combined procedure. Combined TAVI and PCI reduced the mean SYNTAX score significantly from 8.0 ± 5.7 to 3.0 ± 4.9 (P < 0.001) in those patients presenting with severe aortic stenosis and highly significant CAD (Group III). The thirty-day all-cause mortality rate was 5.3, 3.9 and 2.6% for Group I, II and III, respectively (P = 0.609). Patients with highly significant CAD undergoing TAVI and PCI had similar survival up to 3 years as patients without CAD undergoing TAVI only. Radiation time and amount of contrast agent were higher during combined treatment in Group III (P < 0.05). However, no difference in acute kidney injury post-procedurally was observed. CONCLUSIONS Single-stage combined treatment of severe aortic stenosis and highly relevant coronary lesions is a safe and feasible procedure. Early survival and survival up to 3 years are comparable to that observed in patients presenting without CAD who received TAVI only. PCI effectively reduces the complexity of coronary lesions. Although more contrast agent is applied during the combined treatment, the rate of acute kidney injury was not higher.
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Transapical aortic valve implantation in patients with poor left ventricular function and cardiogenic shock. J Thorac Cardiovasc Surg 2014; 148:2877-82.e1. [PMID: 25227698 DOI: 10.1016/j.jtcvs.2014.07.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/01/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES In line with our institutional no exclusion policy we accept patients with very poor left ventricular performance and cardiogenic shock for transcatheter aortic valve implantation (TAVI). The purpose of our study was to analyze outcome in these patients and to identify what happens to the left ventricular function after TAVI in patients with failing ventricles. METHODS Between April 2008 and August 2013, 730 patients underwent transapical TAVI at our institution. The study group consisted of all 104 patients who presented with severely depressed left ventricular function, defined as left ventricular ejection fraction (LVEF) ≤ 30%. Based on the Society of Thoracic Surgeons predicted risk of mortality, the arithmetic risk for surgery in the study cohort was 23% ± 19% (2%-90%), and 23 patients (22%) were in cardiogenic shock. RESULTS Excluding patients in cardiogenic shock, the survival rates in the study group at 1, 2, and 4 years were 81% ± 5%, 65% ± 6%, and 45% ± 8%, respectively. Patients in cardiogenic shock showed significantly worse outcome (P = .048). Improvement in LVEF of 50% or more was found in 74 patients (71%) and 100% or more improvement in 45 patients (43%). Early improvement in LVEF was significantly (P = .049) greater in patients with preoperative values of LVEF ≤ 20%. CONCLUSIONS In the majority of patients with failing ventricles, left ventricular function is quickly restored after TAVI and elimination of aortic stenosis. Without the additional trauma of cardioplegic arrest, TAVI is the potentially superior treatment option in patients with poor and very poor left ventricular performance.
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Abstract
IMPORTANCE Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING, AND PARTICIPANTS Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves. MAIN OUTCOMES AND MEASURES Survival, stroke, and New York Heart Association functional class. RESULTS Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008). CONCLUSIONS AND RELEVANCE In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.
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Bleeding from the apex during transapical transcatheter aortic valve implantation: a simple solution by balloon occlusion of the apex. Interact Cardiovasc Thorac Surg 2014; 19:306-7. [PMID: 24737789 DOI: 10.1093/icvts/ivu110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Bleeding from the apex during transapical transcatheter aortic valve implantation is a potentially catastrophic event, which may seem at first sight to be an uncontrollable circumstance. We describe a simple 'trick' to control this problem that we used successfully in 5 patients. A Fogarty occlusion aortic catheter is gently inserted into the left ventricular cavity through the apical hole used for the transcatheter procedure, the balloon is slowly inflated with 10-15 ml of saline and the catheter is slightly pulled back 1 or 2 cm. This manoeuvre immediately stops the bleeding and enables safe suturing of the apex.
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Distortion of a transcatheter aortic valve after external chest compression. Eur J Cardiothorac Surg 2014; 47:195-6. [PMID: 24686002 DOI: 10.1093/ejcts/ezu139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Elective use of femoro-femoral cardiopulmonary bypass during transcatheter aortic valve implantation†. Eur J Cardiothorac Surg 2014; 47:24-30; discussion 30. [DOI: 10.1093/ejcts/ezu088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Transapical aortic valve implantation: predictors of survival up to 5 years in 730 patients. An update. Eur J Cardiothorac Surg 2014; 47:281-90; discussion 290. [DOI: 10.1093/ejcts/ezu069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Contrast echocardiography: a novel technique for assessment of total aortic regurgitation following transapical aortic valve implantation. Eur J Cardiothorac Surg 2014; 47:18-23. [PMID: 24585552 DOI: 10.1093/ejcts/ezu065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Aortic regurgitation (AR) is a possible complication following transcatheter aortic valve implantation (TAVI) which is associated with less-favourable outcomes. Quantification of total regurgitation caused by multiple, multidirectional jets remains controversial. The purpose of this study was to assess the usefulness of retrograde contrast echocardiography in quantification of total AR following TAVI and to evaluate its prognostic significance. METHODS In 245 patients following Edwards Sapien valve (Edwards Lifesciences, Irvine, CA, USA) implantation, we performed retrograde contrast transoesophageal echocardiography to quantify AR immediately after TAVI. The contrast (20 ml agitated gelatine polysuccinate, Gelafundin 4%, Braun, Melsungen, Germany) was injected as a bolus into the sinotubular junction of the aorta through a pigtail catheter. We measured the area of the regurgitant cloud during mid- to end-diastole. A regurgitant area of ≥3.8 cm2 was determined as an indicator of relevant AR. Sensitivity of this was compared through angiography and Doppler echocardiography. To assess whether AR identified by this novel method independently determined survival, a multivariate model was applied. RESULTS Angiography, Doppler echocardiography and contrast echocardiography recognized 15, 23 and 56 patients with relevant regurgitation. Multivariate analysis including a regurgitant area of ≥3.8 cm2, New York Heart Association (NYHA) class IV, age and creatinine concentration identified a regurgitant area of ≥3.8 cm2 (P=0.027) as independent risk factor for 2-year survival. CONCLUSIONS Contrast echocardiography is a simple method for quantification of total AR following TAVI and is more sensitive than angiography or Doppler echocardiography. Its clinical relevance is demonstrated by the impact of the AR detected by contrast echocardiography on survival.
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Safety considerations during transapical aortic valve implantation. Interact Cardiovasc Thorac Surg 2014; 18:574-9. [DOI: 10.1093/icvts/ivt560] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Postoperative course and survival after transapical aortic valve implantation in patients with pulmonary hypertension. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Transapical aortic valve implantation: Clinical outcome during learning curve and beyond. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Transapical aortic valve implantation after previous heart surgery. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mitral valve and left ventricular reverse remodeling after surgical repair of submitral left ventricular aneurysms assessed with multi-slice computed tomography. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Extended donor criteria in heart transplantation: 4-year results of the experience with the Organ Care system. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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