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Hermens JA, Meuwese CL, Szymanski MK, Gianoli M, van Dijk D, Donker DW. Patient-centered weaning from venoarterial extracorporeal membrane oxygenation: "A practice-oriented narrative review of literature". Perfusion 2023; 38:1349-1359. [PMID: 35939761 DOI: 10.1177/02676591221115938] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Venoarterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used in cardiogenic shock for rapid stabilization and bridging towards recovery, long-term mechanical circulatory support or transplant. Although technological advances have instigated its widespread use, the complex, long-lasting ECMO care creates a significant strain on hospital staff and resources. Therefore, optimal clinical management including timely decisions on ECMO removal and further therapy are pivotal, yet require a well-structured weaning approach. Although dedicated guidelines are lacking, a variety of weaning protocols have distillated echocardiographic and hemodynamic predictors for successful weaning. Nevertheless, a strikingly high mortality up to 70% after initial successful weaning raises concerns about the validity of current weaning strategies. Here, we plead for a patient-tailored approach including a bailout strategy when weaning fails. This should account not only for left- but also right ventricular function and interdependence, as well as the temporal course of cardiac recovery in function of extracorporeal support. Patients with a high risk of weaning failure should be identified early, enabling timely transportation to an advanced heart failure center. This review summarizes predictors of successful weaning and discusses all relevant elements for a structured weaning approach with a central role for patient-specific clinical considerations and echocardiography.
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Affiliation(s)
- Jeannine Aj Hermens
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Christiaan L Meuwese
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Mariusz K Szymanski
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Monica Gianoli
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederik van Dijk
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Dirk W Donker
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
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Vervoorn MT, van Kaam P, Mokhles MM, van der Kaaij NP, Gianoli M. Successful aortic arch cannulation and perfusion of a heart donated after circulatory death: A case report. Perfusion 2023:2676591231200986. [PMID: 37669270 DOI: 10.1177/02676591231200986] [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: 09/07/2023]
Abstract
INTRODUCTION We describe successful aortic arch cannulation and perfusion of a heart donated after circulatory death using the Transmedics Organ Care System™. CASE REPORT A 47-year old man developed advanced heart failure symptoms after prior mustard operation for transposition of the great arteries. He matched a DCD-donor and required an elongated aorta for implantation due to his altered anatomy. The donor heart was retrieved and successfully perfused via aortic arch cannulation for 4.5 h with satisfactory perfusion parameters. DISUSSION Although Transmedics advises against aortic arch cannulation due to concerns regarding malperfusion, satisfactory and safe perfusion can be achieved by careful positioning of the heart. Awareness and attention to the occurrence of malperfusion is mandatory, especially during transport, to achieve satisfactory outcome. CONCLUSION Aortic arch cannulation is feasible without compromising quality of perfusion. This is relevant for patient that require an elongated aorta after surgically corrected congenital heart disease.
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Affiliation(s)
- Mats T Vervoorn
- Department of Cardiothoracic Surgery, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Paul van Kaam
- Heartbeat Dutch Perfusion Services, Kerkstraat, Netherlands
| | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Niels P van der Kaaij
- Department of Cardiothoracic Surgery, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Monica Gianoli
- Department of Cardiothoracic Surgery, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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Felix SEA, Numan L, Oerlemans MIF, Aarts E, Ramjankhan FZ, Gianoli M, Asselbergs FW, de Jonge N, van Laake LW. Incidence and risk factors of late right heart failure in chronic mechanical circulatory support. Artif Organs 2023. [PMID: 37032516 DOI: 10.1111/aor.14537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Late right heart failure (LRHF) is a common complication during long-term left ventricular assist device (LVAD) support. We aimed to identify risk factors for LRHF after LVAD implantation. METHODS Patients undergoing primary LVAD implantation between 2006-2019 and surviving the perioperative period were included for this study (n=261). Univariate Cox proportional hazards analysis was used to assess the association of clinical covariates and LRHF, stratified for device type. Variables with p<0.10 entered the multivariable model. In a subset of patients with complete echocardiography or right catheterization data this multivariable model was extended. Post-operative cardiopulmonary exercise test data were compared in patients with and without LRHF. RESULTS 19% patients suffered from LRHF after a median of 12 months, of which 67% required hospitalization. A history of atrial fibrillation (AF) (HR:2.06 [1.08-3.93], p=0.029), a higher pre-operative body mass index (BMI) (HR: 1.07 [1.01-1.13], p=0.023) and intensive care unit (ICU) duration (HR: 1.03 [1.00-1.06], p=0.025) were independent predictors of LHRF in the multivariable model. A significant relation between the severity of tricuspid regurgitation (TR) and LRHF (HR: 1.91 [1.13-3.21], p=0.016) was found in patients with echocardiographic data. Patients with LRHF demonstrated a lower maximal workload and peak VO2 at 6 months postoperatively. CONCLUSION A history of AF, BMI and longer ICU stay may help identify patients at high risk for LRHF. Severity of TR was significantly related to LRHF in a subset of patients.
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Affiliation(s)
- Susanne E A Felix
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands
- Department of Cardiology, Catharina Hospital Eindhoven, The Netherlands
| | - Lieke Numan
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands
| | - Marish I F Oerlemans
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands
| | - E Aarts
- Department of Methodology and Statistics, Utrecht University, Utrecht, the Netherlands
| | - Faiz Z Ramjankhan
- Department of Cardiothoracic surgery, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands
| | - Monica Gianoli
- Department of Cardiothoracic surgery, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas de Jonge
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands
| | - Linda W van Laake
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands
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Vervoorn M, Van Kaam P, Mokhles M, van der Kaaij N, Gianoli M. Successful Aortic Arch Cannulation and Perfusion of a Heart Donated after Circulatory Death. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.632] [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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de Jong AR, Gianoli M, Namba HF, Roefs MM, Singh S, Segers P, Jacob KA, Suyker WJL. A Nationwide Study of Clinical Outcomes After Robot-Assisted Coronary Artery Bypass Surgery and Hybrid Revascularization in the Netherlands. Innovations (Phila) 2023; 18:73-79. [PMID: 36802970 PMCID: PMC9989225 DOI: 10.1177/15569845231154046] [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: 02/22/2023]
Abstract
OBJECTIVE Robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) surgery and hybrid coronary revascularization (HCR) are minimally invasive alternative strategies to conventional coronary artery bypass surgery in patients with isolated left anterior descending (LAD) stenosis or multivessel coronary disease. We analyzed a large, multicenter data-set based on the Netherlands Heart Registration including all patients undergoing RA-MIDCAB. METHODS We included 440 consecutive patients who underwent RA-MIDCAB with the left internal thoracic artery to LAD between January 2016 and December 2020. A proportion of patients underwent percutaneous coronary intervention (PCI) of non-LAD vessels (i.e., HCR). The primary outcome was all-cause mortality at median follow-up of 1 year, which was subdivided into cardiac and noncardiac. Secondary outcomes included target vessel revascularization (TVR) at median follow-up as well as 30-day mortality, perioperative myocardial infarction, reoperation for bleeding or anastomosis-related problems, and in-hospital ischemic cerebrovascular accident (iCVA). RESULTS Among all patients, 91 (21%) underwent HCR. At median (IQR) follow-up of 19 (8 to 28) months, 11 patients (2.5%) had died. In 7 patients, the cause of death was defined as cardiac. TVR occurred in 25 patients (5.7%), of whom 4 underwent CABG and 21 underwent PCI. At 30-day follow-up, 6 patients (1.4%) had a perioperative myocardial infarction, of whom 1 died. One patient (0.2%) developed an iCVA, and 18 patients (4.1%) underwent reoperation for bleeding or anastomosis-related problems. CONCLUSIONS The clinical outcomes of patients undergoing RA-MIDCAB or HCR in the Netherlands are good and promising when compared with the currently available literature.
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Affiliation(s)
| | | | | | - Maaike M Roefs
- Netherlands Heart Registration, Utrecht, The Netherlands
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Dautzenberg L, Numan L, Knol W, Gianoli M, van der Meer MG, Troost-Oppelaar AM, Westendorp AF, Emmelot-Vonk MH, van Laake LW, Koek HL. Hyperpolypharmacy is a predictor of mortality after left ventricular assist device (LVAD) implantation. Am Heart J Plus 2022; 24:100233. [PMID: 38560633 PMCID: PMC10978416 DOI: 10.1016/j.ahjo.2022.100233] [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: 08/24/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 04/04/2024]
Abstract
Background The prevalence of (hyper)polypharmacy in patients on left ventricular assist device (LVAD) support and its effect on clinical outcomeis unknown. Therefore, we aimed to determine the prevalence of (hyper)polypharmacy in LVAD patients and evaluate its association with mortality and complications. Materials and methods 210 patients aged ≥40 years who received a primary LVAD implantation between 2011 and 2019 were included for analysis. Polypharmacy and hyperpolypharmacy were defined as the concomitant use of 5-9 and ≥10 medications at discharge after LVAD implantation, respectively. Cause specific cox regression was used to assess the association of ≥10 medications with mortality, cardiac arrhythmia, driveline infection and major bleeding. Results The median age of the patients was 57.5 years, and 35.7 % were female. The average number of discharge medications was 8.8 ± 2.3 per patient. The prevalence of patients with 5-9 medications and ≥10 medications was 62.9 % and 34.8 %, respectively. The median follow-up duration was 948 days (interquartile range 874 days). The prescription of ≥10 medications was significantly associated with a higher risk of mortality (HR 2.03; 95 % CI 1.15-3.6, p-value 0.02) adjusted for sex, age, comorbidity and stratified for device type. The prescription of ≥10 medications was not associated with a higher risk of major bleeding, cardiac arrhythmia or driveline infection. Conclusions (Hyper)polypharmacy is highly prevalent in LVAD patients and is independently associated with a higher risk of mortality. Future research is needed to assess the efficacy of individual risk-benefit profiling of (cardiovascular) medication to ensure appropriate polypharmacy and to decrease negative health outcomes.
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Affiliation(s)
- Lauren Dautzenberg
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lieke Numan
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Monica Gianoli
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Manon G. van der Meer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Anne-Marie Troost-Oppelaar
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Aline F. Westendorp
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marielle H. Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Linda W. van Laake
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Huiberdina L. Koek
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
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Palmen M, Navarra E, Bonatti J, Franke U, Cerny S, Musumeci F, Modi P, Singh S, Sandoval E, Pettinari M, Segers P, Gianoli M, van Praet F, de Praetere H, Vojacek J, Cebotaru T, Onan B, Bolcal C, Alhan C, Ouda A, Melly L, Malapert G, Labrousse L, Agnino A, Phillipsen T, Jansens JL, Folliguet T, Suwalski P, Cathenis K, Doguet F, Tomšič A, Oosterlinck W, Pereda D. Current state of the art and recommendations in robotic mitral valve surgery. Interact Cardiovasc Thorac Surg 2022; 35:ivac160. [PMID: 35748726 PMCID: PMC9724768 DOI: 10.1093/icvts/ivac160] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/16/2022] [Accepted: 06/22/2022] [Indexed: 09/29/2023] Open
Affiliation(s)
| | | | - Johannes Bonatti
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
| | | | | | | | - Paul Modi
- Liverpool Heart and Chest, Liverpool, United Kingdom
| | | | | | | | - Patrique Segers
- Maastricht University Medical Center, Maastricht, Netherlands
| | | | | | | | - Jan Vojacek
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Burak Onan
- Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cengiz Bolcal
- Gulhane Education ve Research Hospital, Ankara, Turkey
| | - Cem Alhan
- Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
| | - Ahmed Ouda
- University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | - Thierry Folliguet
- Henri MONDOR Hospital, Assistance Publique Hopitaux de Paris, Creteil, France
| | - Piotr Suwalski
- Central Clinical Hospital of the Ministry of the Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Fabien Doguet
- Cardiovascular Institute Paris Sud, Private Hospital Jacques Cartier, Massy, France
| | - Anton Tomšič
- Leiden University Medical Centre, Leiden, Netherlands
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
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Muller S, Felix S, Rommens C, de Jonge N, Szymanski M, Gianoli M, Ramjankhan F, van Laake L, Oerlemans M. The Value of Physiotherapeutic Tests Next to Cardiopulmonary Exercise Test to Assess Exercise Capacity in Left Ventricular Assist Device Patients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.148] [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: 10/18/2022] Open
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Cerny S, Oosterlinck W, Onan B, Singh S, Segers P, Bolcal C, Alhan C, Navarra E, Pettinari M, Van Praet F, De Praetere H, Vojacek J, Cebotaru T, Modi P, Doguet F, Franke U, Ouda A, Melly L, Malapert G, Labrousse L, Gianoli M, Agnino A, Philipsen T, Jansens JL, Folliguet T, Palmen M, Pereda D, Musumeci F, Suwalski P, Cathenis K, Van den Eynde J, Bonatti J. Corrigendum: Robotic Cardiac Surgery in Europe: Status 2020. Front Cardiovasc Med 2022; 9:870390. [PMID: 35342745 PMCID: PMC8948430 DOI: 10.3389/fcvm.2022.870390] [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] [Received: 02/06/2022] [Accepted: 02/09/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Stepan Cerny
- Na Homolce Hospital, Prague, Czechia
- *Correspondence: Stepan Cerny
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
- Wouter Oosterlinck
| | - Burak Onan
- Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Patrique Segers
- Maastricht University Medical Center, Maastricht, Netherlands
| | - Cengiz Bolcal
- Gulhane Education ve Research Hospital, Ankara, Turkey
| | - Cem Alhan
- Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
| | | | | | | | | | - Jan Vojacek
- University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | | | - Paul Modi
- Liverpool Heart and Chest, Liverpool, United Kingdom
| | | | | | - Ahmed Ouda
- University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | | - Thierry Folliguet
- Henri MONDOR Hospital, Assitance Publique/Hopitaux de Paris, Paris, France
| | | | | | | | - Piotr Suwalski
- Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Jef Van den Eynde
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
- Jef Van den Eynde
| | - Johannes Bonatti
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
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Cerny S, Oosterlinck W, Onan B, Singh S, Segers P, Bolcal C, Alhan C, Navarra E, Pettinari M, Van Praet F, De Praetere H, Vojacek J, Cebotaru T, Modi P, Doguet F, Franke U, Ouda A, Melly L, Malapert G, Labrousse L, Gianoli M, Agnino A, Philipsen T, Jansens JL, Folliguet T, Palmen M, Pereda D, Musumeci F, Suwalski P, Cathenis K, Van den Eynde J, Bonatti J. Robotic Cardiac Surgery in Europe: Status 2020. Front Cardiovasc Med 2022; 8:827515. [PMID: 35127877 PMCID: PMC8811127 DOI: 10.3389/fcvm.2021.827515] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background European surgeons were the first worldwide to use robotic techniques in cardiac surgery and major steps in procedure development were taken in Europe. After a hype in the early 2000s case numbers decreased but due to technological improvements renewed interest can be noted. We assessed the current activities and outcomes in robotically assisted cardiac surgery on the European continent. Methods Data were collected in an international anonymized registry of 26 European centers with a robotic cardiac surgery program. Results During a 4-year period (2016–2019), 2,563 procedures were carried out [30.0% female, 58.5 (15.4) years old, EuroSCORE II 1.56 (1.74)], including robotically assisted coronary bypass grafting (n = 1266, 49.4%), robotic mitral or tricuspid valve surgery (n = 945, 36.9%), isolated atrial septal defect closure (n = 225, 8.8%), left atrial myxoma resection (n = 54, 2.1%), and other procedures (n = 73, 2.8%). The number of procedures doubled during the study period (from n = 435 in 2016 to n = 923 in 2019). The mean cardiopulmonary bypass time in pump assisted cases was 148.6 (63.5) min and the myocardial ischemic time was 88.7 (46.1) min. Conversion to larger thoracic incisions was required in 56 cases (2.2%). Perioperative rates of revision for bleeding, stroke, and mortality were 56 (2.2%), 6 (0.2 %), and 27 (1.1%), respectively. Median postoperative hospital length of stay was 6.6 (6.6) days. Conclusion Robotic cardiac surgery case numbers in Europe are growing fast, including a large spectrum of procedures. Conversion rates are low and clinical outcomes are favorable, indicating safe conduct of these high-tech minimally invasive procedures.
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Affiliation(s)
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
- *Correspondence: Wouter Oosterlinck
| | - Burak Onan
- Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Patrique Segers
- Maastricht University Medical Center, Maastricht, Netherlands
| | - Cengiz Bolcal
- Gulhane Education ve Research Hospital, Ankara, Turkey
| | - Cem Alhan
- Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
| | | | | | | | | | - Jan Vojacek
- University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | | | - Paul Modi
- Liverpool Heart and Chest, Liverpool, United Kingdom
| | | | | | - Ahmed Ouda
- University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | | - Thierry Folliguet
- Henri MONDOR Hospital, Assitance Publique/Hopitaux de Paris, Paris, France
| | | | | | | | - Piotr Suwalski
- Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Jef Van den Eynde
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
- Jef Van den Eynde
| | - Johannes Bonatti
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
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11
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Pettinari M, Gianoli M, Palmen M, Cerny S, Onan B, Singh S, Segers P, Bolcal C, Alhan C, Navarra E, De Praetere H, Vojacek J, Cebotaru T, Modi P, Doguet F, Franke U, Ouda A, Melly L, Malapert G, Labrousse L, Agnino A, Philipsen T, Jansens JL, Folliguet T, Pereda D, Musumeci F, Suwalski P, Cathenis K, Van Praet F, Bonatti J, Oosterlinck W. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6588518. [PMID: 35587697 PMCID: PMC9525087 DOI: 10.1093/icvts/ivac108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Matto Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
- Corresponding author. Ziekenhuis Oost Limburg, Sciepse Bos 6, Genk, Belgium. Tel: +32-89327077; e-mail: (M. Pettinari)
| | - Monica Gianoli
- Department of Cardiac Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Meindert Palmen
- Department of Cardiac Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Stepan Cerny
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Burak Onan
- Department of Cardiac Surgery, Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sandeep Singh
- Department of Cardiac Surgery, ISALA Hospital, Zwolle, Netherlands
| | - Patrique Segers
- Department of Cardiac Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Cengiz Bolcal
- Department of Cardiac Surgery, Gulhane Education ve Research Hospital, Ankara, Turkey
| | - Cem Alhan
- Department of Cardiac Surgery, Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
| | - Emiliano Navarra
- Department of Cardiac Surgery, Cliniques Univesitaires Saint Luc, Brussels, Belgium
| | - Herbert De Praetere
- Department of Cardiac Surgery, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Jan Vojacek
- Department of Cardiac Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Theodor Cebotaru
- Department of Cardiac Surgery, MONZA Hospital, Bucharest, Romania
| | - Paul Modi
- Department of Cardiac Surgery, Liverpool Heart and Chest, Liverpool, United Kingdom
| | - Fabien Doguet
- Department of Cardiac Surgery, Private Hospital Jacques Cartier, Massy, France
| | - Ulrich Franke
- Department of Cardiac Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ahmed Ouda
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ludovic Melly
- Department of Cardiac Surgery, CHU UCL Namur—Site Godinne, Namur, Belgium
| | | | - Louis Labrousse
- Department of Cardiac Surgery, University Hospital Bordeaux, Bordeaux, France
| | - Alfonso Agnino
- Department of Cardiac Surgery, Humanitas Gavazzeni, Bergamo, Italy
| | - Tine Philipsen
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Jean-Luc Jansens
- Department of Cardiac Surgery, Erasme Hospital Brussels, Brussels, Belgium
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpital Henri MONDOR, Assistance Publique-Hôpitaux de Paris, Université Paris 12, Créteil, France
| | - Daniel Pereda
- Department of Cardiac Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Piotr Suwalski
- Department of Cardiac Surgery, Central Teaching Hospital of the Ministry of the Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Koen Cathenis
- Department of Cardiac Surgery, AZ Maria Middelares, Ghent, Belgium
| | - Frank Van Praet
- Department of Cardiac Surgery, Cardiovascular Center, OLV Clinic, Aalst, Belgium
| | - Johannes Bonatti
- Department of Cardiac Surgery, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
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12
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de Jong R, Jacob K, Jalali A, Moharrem Y, Buijsrogge M, Gianoli M, Teefy P, Kiaii B. Five-Year Outcomes After Hybrid Coronary Revascularization: A Single Center Experience. Innovations (Phila) 2021; 16:456-462. [PMID: 34318730 DOI: 10.1177/15569845211031498] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hybrid coronary revascularization (HCR) combines both surgical and percutaneous coronary revascularization procedures. It offers a minimally invasive strategy for multivessel coronary artery disease and combines the advantages of both. However, quantitative long-term patency and clinical outcomes remain understudied. The objective of this study was to assess clinical outcomes and graft and stent patency at 5-year follow-up. METHODS From January 2004 to January 2015, 120 patients were enrolled in this study. They underwent robotically assisted minimally invasive coronary artery bypass grafting of left internal thoracic artery (LITA) to the left descending artery (LAD) and percutaneous coronary intervention of non-LAD vessels. Primary outcome was graft (LITA-LAD) patency determined at 5 years of follow-up, assessed by computed tomography angiography and rest and stress myocardial perfusion scintigraphy (MPS-MIBI). Secondary outcomes were stent patency and major adverse major cardiac and cerebrovascular events (MACCE). Also, freedom from recurrence of angina was assessed. RESULTS At follow-up, 18 of 120 patients (15%) had died (in 5 patients the cause of death was cardiovascular). Among survivors, follow-up was achieved in 83 of 102 (81%). In 76 of 83 patients (92%) there was a patent LITA-LAD graft and in 75 of 83 (90%) a patent stent was demonstrated. MACCE occurred in 36 of 120 patients (30%). Freedom from recurrence of angina occurred in 92 of 120 patients (77%). CONCLUSIONS HCR is a safe and a promising procedure. It provides a minimally invasive approach and results in complete revascularization with good 5-year patency and clinical outcomes.
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Affiliation(s)
- Roos de Jong
- London Health Sciences Center, Ontario, Canada.,569601 University Medical Center Utrecht, The Netherlands
| | - Kirolos Jacob
- 569601 University Medical Center Utrecht, The Netherlands
| | | | | | | | - Monica Gianoli
- 569601 University Medical Center Utrecht, The Netherlands
| | | | - Bob Kiaii
- London Health Sciences Center, Ontario, Canada.,907798789 University of California Davis Medical Center, Sacramento, CA, USA
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13
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Numan L, Ramjankhan FZ, Oberski DL, Oerlemans MIFJ, Aarts E, Gianoli M, Van Der Heijden JJ, De Jonge N, Van Der Kaaij NP, Meuwese CL, Mokhles MM, Oppelaar AM, De Waal EEC, Asselbergs FW, Van Laake LW. Propensity score-based analysis of long-term outcome of patients on HeartWare and HeartMate 3 left ventricular assist device support. ESC Heart Fail 2021; 8:1596-1603. [PMID: 33635573 PMCID: PMC8006731 DOI: 10.1002/ehf2.13267] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/24/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 12/31/2022] Open
Abstract
Aims Left ventricular assist device therapy has become the cornerstone in the treatment of end‐stage heart failure and is increasingly used as destination therapy next to bridge to transplant or recovery. HeartMate 3 (HM3) and HeartWare (HVAD) are centrifugal continuous flow devices implanted intrapericardially and most commonly used worldwide. No randomized controlled trials have been performed yet. Analysis based on large registries may be considered as the best alternative but has the disadvantage of different standard of care between centres and missing data. Bias is introduced, because the decision which device to use was not random, even more so because many centres use only one type of left ventricular assist device. Therefore, we performed a propensity score (PS)‐based analysis of long‐term clinical outcome of patients that received HM3 or HVAD in a single centre. Methods and results Between December 2010 and December 2019, 100 patients received HVAD and 81 patients HM3 as primary implantation at the University Medical Centre Utrecht. We performed PS matching with an extensive set of covariates, resulting in 112 matched patients with a median follow‐up of 28 months. After PS matching, survival was not significantly different (P = 0.21) but was better for HM3. The cumulative incidences for haemorrhagic stroke (P = 0.01) and pump thrombosis (P = 0.02) were significantly higher for HVAD patients. The cumulative incidences for major bleeding, ischaemic stroke, right heart failure, and driveline infection were not different between the groups. We found no interaction between the surgeon who performed the implantation and survival (P = 0.59, P = 0.78, and P = 0.89). Sensitivity analysis was performed, by PS matching without patients on preoperative temporary support resulting in 74 matched patients. This also resulted in a non‐significant difference in survival (P = 0.07). The PS‐adjusted Cox regression showed a worse but non‐significant (P = 0.10) survival for HVAD patients with hazard ratio 1.71 (95% confidence interval 0.91–3.24). Conclusions Survival was not significantly different between both groups after PS matching, but was better for HM3, with a significantly lower incidence of haemorrhagic stroke and pump thrombosis for HM3. These results need to be interpreted carefully, because matching may have introduced greater imbalance on unmeasured covariates. A multicentre approach of carefully selected centres is recommended to enlarge the number of matched patients.
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Affiliation(s)
- Lieke Numan
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Faiz Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Daniel L Oberski
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Martinus I F J Oerlemans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Emmeke Aarts
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Monica Gianoli
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joris J Van Der Heijden
- Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas De Jonge
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Niels P Van Der Kaaij
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Christiaan L Meuwese
- Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne-Marie Oppelaar
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eric E C De Waal
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Linda W Van Laake
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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14
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Zebele C, Gianoli M, Elenbaas T, Brink PRG, Van Zundert AAJ. An unusual case of left chest stab wound. Asian Cardiovasc Thorac Ann 2011; 19:349-51. [PMID: 22100931 DOI: 10.1177/0218492311419173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 72-year-old man was admitted with one blade of a huge pair of shears in his left thorax. His hemodynamics deteriorated due to life-threatening vascular lesions. An urgent thoracotomy revealed several injuries to the intercostal vessels and left apical inferior lung lobe. The blade tip was stuck in the posterior chest wall, 2 cm adjacent to the descending aorta. The blade was removed, the lung was sutured, and the patient made a good recovery.
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Affiliation(s)
- Carlo Zebele
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
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15
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Mariani MA, Diephuis JC, Kuipers MJH, Gianoli M, Grandjean JG. Off-Pump Coronary Artery Bypass Graft Surgery With a Pulsatile Catheter Pump for Left Ventricular Dysfunction. Ann Thorac Surg 2007; 84:690-2. [PMID: 17643674 DOI: 10.1016/j.athoracsur.2006.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 11/01/2006] [Accepted: 12/11/2006] [Indexed: 11/19/2022]
Abstract
We describe the use of a novel device, the pulsatile catheter pump, in patients with left ventricular dysfunction undergoing off-pump coronary surgery. During a 1-year period, 14 patients (mean ejection fraction 28% +/- 8%) underwent off-pump coronary surgery using the pulsatile catheter pump. We recorded neither mortality nor major adverse cardiovascular and cerebral events. Mean support time was 55 +/- 13 minutes. The average flow generated by the pulsatile catheter pump, as calculated per patient, was 2.4 +/- 0.2 L/min (range, 2.2 to 2.8 L/min). Our results show that the pulsatile catheter pump is clinically safe and provides adequate mechanical circulatory support in patients with impaired left ventricular function undergoing off-pump coronary artery surgery.
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Affiliation(s)
- Massimo A Mariani
- Cardiothoracic Surgery, Thoraxcentrum Twente, Enschede, The Netherlands.
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Perseghin P, Sciorelli G, Belotti D, Speranza T, Pogliani EM, Ferro O, Gianoli M, Porta F, Paolini G. Frozen-and-thawed allogeneic platelet gels for treating postoperative chronic wounds. Transfusion 2005; 45:1544-6. [PMID: 16131392 DOI: 10.1111/j.1537-2995.2005.00570.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Gianoli M, Formica F, Ferro O, Colagrande L, Gastaldi D, Chiodini P, Paolini G. The early outcome in patients undergoing off-pump coronary artery bypass grafting: our experience. Ital Heart J 2005; 6:640-6. [PMID: 16161497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Many studies confirm that beating heart surgery is an alternative to on-pump myocardial revascularization. However, the clinical conditions of patients are currently considered as a major landmark in the indication for beating heart surgery. This retrospective non-randomized study was carried out to evaluate the efficacy and the advantages of this surgical technique when anatomical criteria are used to choose the surgical strategy. METHODS From February to December 2003, 222 consecutive patients underwent isolated myocardial revascularization: 76 (34%) with an off-pump coronary artery bypass (OPCAB) and 146 (66%) with an on-pump coronary artery bypass (ONCAB) procedure. Selection for surgical treatment was based on coronary anatomy. All patients were stratified for mortality risk class according to the EuroSCORE system. Operative and postoperative data were analyzed. RESULTS Morbidity and mortality did not differ significantly between the two groups but the release of creatine kinase-MB fraction was significantly higher in the ONCAB group (48.7 +/- 55.3 vs 20.8 +/- 16.6 U/ml, p < 0.001). Patients at high surgical risk were dealt with a more complicated clinical outcome; logistic regression analysis showed that this class was an independent risk factor for postoperative complications in both groups. CONCLUSIONS We did not find any statistical difference in hospital mortality and morbidity either using ONCAB or OPCAB; however a lower release of creatine kinase-MB in beating heart revascularization group suggests that OPCAB reduces myocardial injury and preserves cardiac function when anatomical criteria are considered for patient selection.
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Affiliation(s)
- Monica Gianoli
- Cardiac Surgery Clinic, Department of Surgical Science and Intensive Care, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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