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Leidenberger T, Gordon Y, Farag M, Delles M, Fava Sanches A, Fink MA, Kallenbach K, Kauczor HU, Rengier F. Imaging-Based 4D Aortic Pressure Mapping in Marfan Syndrome Patients: A Matched Case-Control Study. Ann Thorac Surg 2019; 109:1434-1440. [PMID: 31568745 DOI: 10.1016/j.athoracsur.2019.08.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/06/2019] [Revised: 07/22/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Marfan syndrome predisposes to aortic aneurysm, dissection, and rupture. We sought to investigate aortic 4-dimensional (4D) relative pressure maps derived from 4D flow cardiovascular magnetic resonance to identify disease characteristic alterations of the intraaortic pressure field in Marfan patients with aortic root dilation compared with age- and sex-matched healthy controls. METHODS This prospective case-control study included 11 Marfan patients with aortic root dilation (31 ± 5 years, 5 female) and 11 age- and sex-matched healthy controls (31 ± 8 years, 5 female) undergoing 4D flow cardiovascular magnetic resonance of the thoracic aorta. 4D relative pressure maps were computed and compared between groups for 8 aortic regions. RESULTS Aortic root diameters were significantly larger in patients compared with controls (43 vs 31 mm, P < .001), but not in the proximal descending aorta (23 vs 21 mm, P = .19). Regional pressure gradients over the cardiac cycle were significantly altered in Marfan patients with significantly higher minimum pressure gradients in the proximal ascending aorta (-44.3 vs -97.0 mm Hg/m, P < .001) and significantly lower maximum pressure gradients in the proximal descending aorta (55.1 vs 82.3 mm Hg/m, P < .01). The latter finding was associated with pathologic vortical flow patterns. Regional pressure gradient at mid systole significantly correlated with aortic diameter (proximal ascending aorta: r = 0.73, P < .001; proximal descending aorta: r = -0.59, P = .004). CONCLUSIONS Noninvasive 4D pressure mapping derived from 4D flow cardiovascular magnetic resonance revealed significant alterations of spatiotemporal pressure characteristics in the thoracic aorta of Marfan patients. These alterations were most pronounced in the proximal ascending aorta and the proximal descending aorta, corresponding to the regions where aortic dissections often originate in Marfan patients.
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Affiliation(s)
- Tilman Leidenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Yaron Gordon
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany; Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Delles
- Department of Informatics, Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Augusto Fava Sanches
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias A Fink
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Kallenbach
- Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany; Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany; Department of Cardiac Surgery, INCCI HaerzZenter, Luxembourg, Luxembourg
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC), University of Heidelberg, Heidelberg, Germany
| | - Fabian Rengier
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC), University of Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
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Kremer J, Farag M, Zaradzki M, Szabó G, Ruhparwar A, Kallenbach K, Karck M, Arif R. The reimplantation valve-sparing aortic root replacement technique for patients with Marfan syndrome: A single-center experience. Sci Rep 2019; 9:12021. [PMID: 31427685 PMCID: PMC6700152 DOI: 10.1038/s41598-019-48572-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/03/2019] [Accepted: 08/07/2019] [Indexed: 01/26/2023] Open
Abstract
Valve-sparing aortic root replacement (VSARR) through reimplantation technique is widely regarded as optimal surgical approach for Marfan syndrome (MFS) patients. Perioperative and long-term data from all MFS patients undergoing VSARR using David's technique at our center from 2007-2018 were analyzed. We included 56 patients with a mean age of 32.3 ± 12.3 years. Logistic EuroSCORE was 7.96 ± 5.2. Among others concomitant surgical procedures included aortic arch surgery (8.9%), mitral valve repair (23.2%) and replacement (1.7%). There were no operative deaths, nor in-hospital-mortality. One patient underwent re-exploration for bleeding, dialysis and pacemaker implantation was required in one case each. There was no occurrence of low-output syndrome nor neurological complications. Significant gender differences were not found, except for intraoperative blood transfusion occurring significantly more often in the female gender (p = 0.009). Despite significantly longer procedural times, concomitant surgery did not negatively impact overall outcome. Freedom of reoperation of the aortic root was 100% at 1 year, 97.7% at 8 years. Until last follow-up (61 ± 38 month) all patients survived, with no evidence of endocarditis. We emphasize once more that VSARR using David's procedure is a safe method for MFS patients with excellent long-term results even if concomitant procedures are performed.
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Affiliation(s)
- Jamila Kremer
- Marfan Center University Hospital Heidelberg, Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Marfan Center University Hospital Heidelberg, Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcin Zaradzki
- Marfan Center University Hospital Heidelberg, Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabor Szabó
- Marfan Center University Hospital Heidelberg, Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Marfan Center University Hospital Heidelberg, Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Kallenbach
- Marfan Center University Hospital Heidelberg, Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany.,INCCI HaerzZenter, Department of Cardiac Surgery, Luxembourg City, Luxembourg
| | - Matthias Karck
- Marfan Center University Hospital Heidelberg, Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Marfan Center University Hospital Heidelberg, Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany.
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53
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Farag M, Veres G, Szabó G, Ruhparwar A, Karck M, Arif R. Hyperbilirubinaemia after cardiac surgery: the point of no return. ESC Heart Fail 2019; 6:694-700. [PMID: 31095903 PMCID: PMC6676269 DOI: 10.1002/ehf2.12447] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/09/2019] [Indexed: 01/15/2023] Open
Abstract
Aims The occurrence of hyperbilirubinaemia after heart surgery using cardiopulmonary bypass or post‐operative heart failure is fairly common. We investigated the incidence, predictive value, and post‐operative outcome of hyperbilirubinaemia after cardiac surgery in an effort to identify potential risk factors and significance on clinical outcome. Methods and results Between 2006 and 2016, 1272 (10.1%) out of 12 556 patients developed hyperbilirubinaemia, defined as bilirubin concentration >3 mg/dL, during post‐operative course at our institution. All patients who were operated using cardiopulmonary bypass were included. Hepatic dysfunction was diagnosed preoperatively in 200 patients (15.7%), whereas mean model of end‐stage liver disease score was 11.22 ± 4.99. Early mortality was 17.4% with age [hazard ratio (HR) 1.019, 95% confidence interval (CI) 1.008–1.029; P = 0.001], diabetes (HR 1.115, CI 1.020–1.220; P = 0.017), and emergent procedures (HR 1.315, CI 1.012–1.710) as multivariate predictors. Post‐operative predictors were low‐output syndrome (HR 3.193, 95% CI 2.495–4.086; P < 0.001), blood transfusion (HR 1.0, CI 1.0–1.0; P < 0.001), and time to peak bilirubin (HR 1.1, CI 1.0–1.1; P < 0.001). We found an increased correlation with mortality at 3.5 post‐operative day as well as an optimal cut‐off value for bilirubin of 5.35 mg/dL. A maximum bilirubin of 25.5 mg/dL was associated with 99% mortality. Survival analysis showed significantly decreased survival for patients who developed late, rather than early, hyperbilirubinaemia. Conclusions Post‐operative hyperbilirubinaemia is a prevalent threat after cardiopulmonary bypass, associated with high early mortality. The timing and amount of peak bilirubin concentration are linked to the underlying pathology and are predictors of post‐operative outcome. Patients with late development of steep hyperbilirubinaemia warrant meticulous post‐operative care optimizing cardiac and end organ functions before reaching the point of no return.
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Affiliation(s)
- Mina Farag
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabor Veres
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabor Szabó
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
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54
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Schmack B, Farag M, Kremer J, Grossekettler L, Brcic A, Raake PW, Kreusser MM, Goldwasser R, Popov AF, Mansur A, Karck M, Ruhparwar A. Results of concomitant groin-free percutaneous temporary RVAD support using a centrifugal pump with a double-lumen jugular venous cannula in LVAD patients. J Thorac Dis 2019; 11:S913-S920. [PMID: 31183170 DOI: 10.21037/jtd.2018.11.121] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Modern left ventricular assist devices (LVAD) have evolved to become standard of care in severe heart failure (HF) patients. Right HF (RHF) is a major complication responsible for early mortality. Several techniques for temporary right ventricular assist device (t-RVAD) have been described before, baring relevant disadvantages such as limited mobilization or the need for re-thoracotomy. We describe the results of an alternative technique for t-RVAD using the Tandem Heart™ with ProtekDuo™ cannula. Methods An institutional retrospective single centre outcome analysis was performed including all permanent LVAD recipients with concomitant groin-free t-RVAD support. Results Between October 2015 and September 2017, 11 patients (10 male, 90.9%) were included. Preoperative NYHA class was 3.8±0.75 and INTERMACS class 3.5±1.5. Four (36.4%) patients were already on mechanical circulatory support (MCS) at time of implantation with 4 (36.4%) patients already on inotropic support. All LVAD implantations were performed on-pump and 3 cases (27.3%) were re-do cases. Mean t-RVAD duration was 16.8±9.5 days. Ten patients (90.9%) could be weaned from temporary RVAD support, 1 patient deceased on support. Mean ICU stay was 23.8±16.5 days, while 30-day survival was 72.7%. Follow-up was complete with 214.7±283 days. Three patients (27.3%) died following multi-organ failure (MOF), 1 patient (9.1%) following intracranial bleed 12 days after t-RVAD explantation. No severe t-RVAD associated complications were observed. Conclusions Our technique allows for safe groin-free t-RVAD providing all advantages of percutaneous implantation including complete mobilization and bedside explantation without any need for operation.
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Affiliation(s)
- Bastian Schmack
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Jamila Kremer
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Leonie Grossekettler
- Department of Internal Medicine III, Cardiology, Angiology, Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Andreas Brcic
- Department of Anaesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Cardiology, Angiology, Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Cardiology, Angiology, Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ranny Goldwasser
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Aron-Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Ashham Mansur
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
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55
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Arif R, Farag M, Veres G, Al-Maisary S, Dib B, Kallenbach K, Karck M, Szabo G. Sutureless and Rapid-Deployment Aortic Valves versus TA-TAVI: A Matched Pairs Analysis. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R. Arif
- Department of Cardiac Surgery, Heidelberg University, Heidelberg, Germany
| | - M. Farag
- Department of Cardiac Surgery, Heidelberg University, Heidelberg, Germany
| | - G. Veres
- Department of Cardiac Surgery, Heidelberg University, Heidelberg, Germany
| | - S. Al-Maisary
- Department of Cardiac Surgery, Heidelberg University, Heidelberg, Germany
| | - B. Dib
- Department of Cardiac Surgery, Heidelberg University, Heidelberg, Germany
| | - K. Kallenbach
- Department of Cardiac Surgery, INCCI Heart Center, Luxembourg, Luxembourg
| | - M. Karck
- Department of Cardiac Surgery, Heidelberg University, Heidelberg, Germany
| | - G. Szabo
- Department of Cardiac Surgery, Heidelberg University, Heidelberg, Germany
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56
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Shoaib A, Farag M, Nolan J, Rigby A, Patwala A, Rashid M, Kwok CS, Perveen R, Clark AL, Komajda M, Cleland JGF. Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey. Clin Res Cardiol 2018; 108:510-519. [PMID: 30361818 PMCID: PMC6484773 DOI: 10.1007/s00392-018-1380-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Heart failure is heterogeneous in aetiology, pathophysiology, and presentation. Despite this diversity, clinical trials of patients hospitalized for HF deal with this problem as a single entity, which may be one reason for repeated failures. METHODS The first EuroHeart Failure Survey screened consecutive deaths and discharges of patients with suspected heart failure during 2000-2001. Patients were sorted into seven mutually exclusive hierarchical presentations: (1) with cardiac arrest/ventricular arrhythmia; (2) with acute coronary syndrome; (3) with rapid atrial fibrillation; (4) with acute breathlessness; (5) with other symptoms/signs such as peripheral oedema; (6) with stable symptoms; and (7) others in whom the contribution of HF to admission was not clear. RESULTS The 10,701 patients enrolled were classified into the above seven presentations as follows: 260 (2%), 560 (5%), 799 (8%), 2479 (24%), 1040 (10%), 703 (7%), and 4691 (45%) for which index-admission mortality was 26%, 20%, 10%, 8%, 6%, 6%, and 4%, respectively. Compared to those in group 7, the hazard ratios for death during the index admission were 4.9 (p ≤ 0.001), 4.0 (p < 0.001), 2.2 (p < 0.001), 2.1 (p < 0.001), 1.4 (p < 0.04) and 1.4 (p = 0.04), respectively. These differences were no longer statistically significant by 12 weeks. CONCLUSION There is great diversity in the presentation of heart failure that is associated with very different short-term outcomes. Only a minority of hospitalizations associated with suspected heart failure are associated with acute breathlessness. This should be taken into account in the design of future clinical trials.
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Affiliation(s)
- Ahmad Shoaib
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK.
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK.
| | - M Farag
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - J Nolan
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - A Rigby
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK
| | - A Patwala
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - M Rashid
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - C S Kwok
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - R Perveen
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK
| | - A L Clark
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK
| | - M Komajda
- Department of Cardiology, University of Pierre and Marie Curie Paris VI, La Pitié-Salpêtrière Hospital, Paris, France
| | - J G F Cleland
- Robertson Centre for Biostatistics, University of Glasgow and National Heart and Lung Institute, Imperial College London, London, UK
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Saleeb RM, Farag M, Lichner Z, Brimo F, Bartlett J, Bjarnason G, Finelli A, Rontondo F, Downes MR, Yousef GM. Modulating ATP binding cassette transporters in papillary renal cell carcinoma type 2 enhances its response to targeted molecular therapy. Mol Oncol 2018; 12:1673-1688. [PMID: 29896907 PMCID: PMC6165997 DOI: 10.1002/1878-0261.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/28/2022] Open
Abstract
Papillary renal cell carcinoma (PRCC) is the most common nonclear cell RCCs and is known to comprise two histological subtypes. PRCC2 is more aggressive and is molecularly distinct from the other subtypes. Despite this, PRCCs are treated together as one entity, and they show poor response to the current therapies that do not target pathways implicated in their pathogenesis. We have previously detected ABCC2 (an ABC transporter), VEGF, and mTOR pathways to be enriched in PRCC2. In this study, we assess the therapeutic potential of targeting these pathways in PRCC2. Twenty RCC cell lines from the Cancer Cell Encyclopedia were compared to the Cancer Genome Atlas PRCC cohort (290), to identify representative PRCC2 cell lines. Cell lines were further validated in xenograft models. Selected cell lines were treated in vitro and in vivo (mice models) under five different conditions, untreated, anti-VEGF (sunitinib), ABCC2 blocker (MK571), mTOR inhibitor (everolimus) and sunitinib + MK571. Sunitinib +ABCC2 blocker group showed a significant response to therapy compared to the other treatment groups both in vitro (P ≤ 0.0001) and in vivo (P = 0.0132). ABCC2 blockage resulted in higher sunitinib uptake, both in vitro (P = 0.0016) and in vivo (P = 0.0031). Everolimus group demonstrated the second best response in vivo. The double-treatment group showed the highest apoptotic rate and lowest proliferation rate. There is an urgent need for individualized therapies of RCC subtypes that take into account their specific biology. Our results demonstrate that combined targeted therapy with sunitinib and ABCC2 blocker in PRCC2 has therapeutic potential. The results are likewise potentially significant for other ABCC2 high tumors. However, the results are preliminary and clinical trials are needed to confirm these effects in PRCC2 patients.
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Affiliation(s)
- Rola M. Saleeb
- Department of Laboratory Medicine, and the Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoCanada
| | - Mina Farag
- Department of Laboratory Medicine, and the Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
| | - Zsuzsanna Lichner
- Department of Laboratory Medicine, and the Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
| | - Fadi Brimo
- Department of PathologyMcGill University Health CenterMontrealCanada
| | - Jenni Bartlett
- Department of Laboratory Medicine, and the Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
| | - Georg Bjarnason
- Division of Medical Oncology and HematologySunnybrook Health SciencesTorontoCanada
| | - Antonio Finelli
- Division of UrologyDepartment of SurgeryUniversity Health NetworkTorontoCanada
| | - Fabio Rontondo
- Department of Laboratory Medicine, and the Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
| | | | - George M. Yousef
- Department of Laboratory Medicine, and the Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoCanada
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Farag M, Spinthakis N, Gue Y, Srinivasan M, Sullivan K, Wellsted D, Gorog DA. 2151Impaired endogenous fibrinolysis in STEMI patients undergoing PPCI is an independent predictor of recurrent cardiovascular events -the RISK PPCI study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Farag
- East and North Hertfordshire NHS Trust, Department of Cardiology, Hertfordshire, United Kingdom
| | - N Spinthakis
- East and North Hertfordshire NHS Trust, Department of Cardiology, Hertfordshire, United Kingdom
| | - Y Gue
- East and North Hertfordshire NHS Trust, Department of Cardiology, Hertfordshire, United Kingdom
| | - M Srinivasan
- East and North Hertfordshire NHS Trust, Department of Cardiology, Hertfordshire, United Kingdom
| | - K Sullivan
- University of Hertfordshire, Postgraduate Medical School, Hertfordshire, United Kingdom
| | - D Wellsted
- University of Hertfordshire, Postgraduate Medical School, Hertfordshire, United Kingdom
| | - D A Gorog
- Imperial College London, London, United Kingdom
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Lichner Z, Saleeb R, Butz H, Ding Q, Nofech-Mozes R, Riad S, Farag M, Varkouhi AK, Dos Santos CC, Kapus A, Yousef GM. Sunitinib induces early histomolecular changes in a subset of renal cancer cells that contribute to resistance. FASEB J 2018; 33:1347-1359. [PMID: 30148679 DOI: 10.1096/fj.201800596r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sunitinib is the standard-of-care, first-line treatment for advanced renal cell carcinoma (RCC). Characteristics of treatment-resistant RCC have been described; however, complex tumor adaptation mechanisms obstruct the identification of significant operators in resistance. We hypothesized that resistance is a late manifestation of early, treatment-induced histomolecular alterations; therefore, studying early drug response may identify drivers of resistance. We describe an epithelioid RCC growth pattern in RCC xenografts, which emerges in sunitinib-sensitive tumors and is augmented during resistance. This growth modality is molecularly and morphologically related to the RCC spheroids that advance during in vitro treatment. Based on time-lapse microscopy, mRNA and microRNA screening, and tumor behavior-related characteristics, we propose that the spheroid and adherent RCC growth patterns differentially respond to sunitinib. Gene expression analysis indicated that sunitinib promoted spheroid formation, which provided a selective survival advantage under treatment. Functional studies confirm that E-cadherin is a key contributor to the survival of RCC cells under sunitinib treatment. In summary, we suggest that sunitinib-resistant RCC cells exist in treatment-sensitive tumors and are histologically identifiable.-Lichner, Z., Saleeb, R., Butz, H., Ding, Q., Nofech-Mozes, R., Riad, S., Farag, M., Varkouhi, A. K., dos Santos, C. C., Kapus, A., Yousef, G. M. Sunitinib induces early histomolecular changes in a subset of renal cancer cells that contribute to resistance.
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Affiliation(s)
- Zsuzsanna Lichner
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Rola Saleeb
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Henriett Butz
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Molecular Medicine Research Group, Hungarian Academy of Sciences and Semmelweis University (HAS-SE), Budapest, Hungary
| | - Qiang Ding
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Roy Nofech-Mozes
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sara Riad
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mina Farag
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amir K Varkouhi
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Viral Vector and Cell Therapy Core (VICTOR), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Claudia C Dos Santos
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Viral Vector and Cell Therapy Core (VICTOR), St. Michael's Hospital, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - András Kapus
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada; and.,Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada
| | - George M Yousef
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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60
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Gue YX, Farag M, Spinthakis N, Anwar M, Gorog DA, Srinivasan M. P4651Incidence of MINOCA in patients presenting with STEMI for PPCI- applying the criteria of the ESC working group position paper on MINOCA to a contemporary cohort. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y X Gue
- Lister Hospital, Stevenage, United Kingdom
| | - M Farag
- Lister Hospital, Stevenage, United Kingdom
| | | | - M Anwar
- Lister Hospital, Stevenage, United Kingdom
| | - D A Gorog
- Imperial College London, National heart and lung institute, London, United Kingdom
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Bethune R, Absher N, Obiagwu M, Qarmout T, Steeves M, Yaghoubi M, Tikoo R, Szafron M, Dell C, Farag M. Social determinants of self-reported health for Canada's indigenous peoples: a public health approach. Public Health 2018; 176:172-180. [PMID: 29666024 DOI: 10.1016/j.puhe.2018.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 10/09/2017] [Revised: 02/07/2018] [Accepted: 03/06/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In Canada, indigenous peoples suffer from a multitude of health disparities. To better understand these disparities, this study aims to examine the social determinants of self-reported health for indigenous peoples in Canada. STUDY DESIGN This study uses data from Statistics Canada's Aboriginal Peoples Survey 2012. METHODS Multinomial logistic regression models were used to examine how selected social determinants of health are associated with self-reported health among off-reserve First Nations and Métis peoples in Canada. RESULTS Our analysis shows that being older, female, and living in urban settings were significantly associated with negative ratings of self-reported health status among the indigenous respondents. Additionally, we found that higher income and levels of education were strongly and significantly associated with positive ratings of self-reported health status. Compared with indigenous peoples with an education level of grade 8 or lower, respondents with higher education were 10 times (5.35-22.48) more likely to report 'excellent' and 'very good' health. Respondents who earned more than $40,000 annually were three times (2.17-4.72) more likely to report 'excellent' and 'very good' health compared with those who earned less than $20,000 annually. When interacted with income, we also found that volunteering in the community is associated with better self-reported health. CONCLUSIONS There are known protective determinants (income and education) and risk determinants (location of residence, gender, and age) which are associated with self-reported health status among off-reserve First Nations and Métis peoples. For indigenous-specific determinants, volunteering in the community appears to be associated with self-perceived health status. Thus, addressing these determinants will be necessary to achieve better health outcomes for indigenous peoples in Canada. Next steps include developing indigenous-specific social determinants of health indicators that adequately measure culture, connection, and community.
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Affiliation(s)
- R Bethune
- School of Public Health, University of Saskatchewan, Canada.
| | - N Absher
- School of Public Health, University of Saskatchewan, Canada.
| | - M Obiagwu
- School of Public Health, University of Saskatchewan, Canada.
| | - T Qarmout
- School of Public Administration and Development Economics, Doha Institute for Graduate Studies, Qatar.
| | - M Steeves
- School of Public Health, University of Saskatchewan, Canada.
| | - M Yaghoubi
- School of Public Health, University of Saskatchewan, Canada.
| | - R Tikoo
- School of Public Health, University of Saskatchewan, Canada.
| | - M Szafron
- School of Public Health, University of Saskatchewan, Canada.
| | - C Dell
- College of Arts and Science, Department of Sociology, University of Saskatchewan, Canada.
| | - M Farag
- School of Public Health, University of Saskatchewan, Canada.
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Schmack B, Kremer J, Brcic A, Grossekettler L, Goldwasser R, Arif R, Farag M, Schmidt H, Kreusser M, Raake P, Karck M, Ruhparwar A. Results of Concomitant Percutaneous Temporary RVAD Support Using the Cardiac Assist TandemHeart With ProtekDuo Cannula in LVAD Patients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abdelrahman T, Latif A, Chan D, Jones H, Farag M, Lewis W, Havard T, Escofet X. Outcomes after laparoscopic anti-reflux surgery related to obesity: A systematic review and meta-analysis. Int J Surg 2018; 51:76-82. [DOI: 10.1016/j.ijsu.2018.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
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Szczechowicz M, Mkalaluh S, Farag M, Mashhour A, Loukanov T, Kolcz J, Karck M, Weymann A. Pulmonary valve and right ventricular outflow tract surgery in adults: 23-year experience. Kardiol Pol 2018; 76:602-610. [PMID: 29297190 DOI: 10.5603/kp.a2017.0260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/16/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgery of the pulmonary valve, right ventricular outflow tract, and pulmonary artery falls under the domain of paediatric cardiac surgery. However, 97 adult patients underwent such operations in our institution from 1993 to 2016. AIM This study aims to analyse preoperative risk factors, intraoperative data, postoperative outcomes, and long-term survival to identify the potential predictors of mortality and high-risk patients. METHODS We divided our patient cohort into three groups in accordance with surgical indications: 17 patients with pulmonary valve endocarditis (group A), 70 patients with congenital defects involving the pulmonary valve (group B), and 10 patients who underwent pulmonary valve surgery for other indications, such as tumour or other acquired valvular disease (group C). RESULTS Gender distribution was comparable in all the three groups, with about 40% of the total number of patients being female. The mean age was 35.9 ± 15.7 years. Sixty (61.9%) patients had a history of cardiac surgery. Various concomitant cardiac surgical procedures were necessary in 49 (50.5%) cases. There were two (11.8%) in-hospital deaths in group A, two (2.9%) in group B, and none in group C. Within the mean follow-up time of 6.6 ±7.2 years, three (17.7%) patients in group A, two (2.9%) in group B, and four (40%) in group C died. CONCLUSIONS Adult patients with pulmonary valve disease are often previously heart-operated and often need concomitant procedures. The operative risk in patients with pulmonary valve endocarditis is high. Surgery of congenital defects of the pulmonary valve is safe and can be performed with excellent outcomes.
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Affiliation(s)
- Marcin Szczechowicz
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany; Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, INF 110, 69120 Heidelberg, Germany..
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Gustin JP, Miller J, Farag M, Rosen DM, Thomas M, Scharpf RB, Lauring J. GATA3 frameshift mutation promotes tumor growth in human luminal breast cancer cells and induces transcriptional changes seen in primary GATA3 mutant breast cancers. Oncotarget 2017; 8:103415-103427. [PMID: 29262572 PMCID: PMC5732738 DOI: 10.18632/oncotarget.21910] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 12/29/2022] Open
Abstract
The GATA3 transcription factor is one of the most frequently mutated genes in breast cancer. Heterozygous mutations, mostly frameshifts, are seen in 15% of estrogen receptor positive breast cancers, the subtype in which these mutations are almost exclusively found. Mouse studies have shown that Gata3 is critical for breast development and that GATA3 gene dosage affects breast tumor progression. Human patient data have shown that high Gata3 expression, a feature of luminal subtype breast cancers, is associated with a better prognosis. Although the frequency of GATA3 mutation suggests an important role in breast cancer development or progression, there is little understanding of how mutations in GATA3 affect its function in luminal breast epithelial cells and what gene expression changes result as a consequence of the mutations. Here, using gene editing, we have created two sets of isogenic human luminal breast cancer cell lines with and without a hotspot truncating GATA3 mutation. GATA3 mutation enhanced tumor growth in vivo but did not affect sensitivity to clinically used hormonal therapies or chemotherapeutic agents. We identified genes with upregulated and downregulated expression in GATA3 mutant cells, a subset of which was concordantly differentially expressed in GATA3 mutant primary luminal breast cancers. Addback of mutant GATA3 recapitulated mutation-specific gene expression changes and enhanced soft agar colony formation, suggesting a gain of function for the mutant protein.
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Affiliation(s)
- John P Gustin
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Jernelle Miller
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Mina Farag
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - D Marc Rosen
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Matthew Thomas
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Robert B Scharpf
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Josh Lauring
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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Schmack B, Seppelt P, Weymann A, Alt C, Farag M, Arif R, Doesch AO, Raake PW, Kallenbach K, Mansur A, Popov AF, Karck M, Ruhparwar A. Extracorporeal life support with left ventricular decompression-improved survival in severe cardiogenic shock: results from a retrospective study. PeerJ 2017; 5:e3813. [PMID: 28975053 PMCID: PMC5624302 DOI: 10.7717/peerj.3813] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 07/10/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023] Open
Abstract
Objective Extracorporeal life support (ECLS) is a life-saving procedure used in the treatment of severe cardiogenic shock. Within this retrospective single centre study, we examined our experience in this critically ill patient cohort to assess outcomes and clinical parameters by comparison of ECLS with or without selective left ventricular decompression. Methods Between 2004 and 2014 we evaluated 48 adult patients with INTERMACS level 1 heart failure (age 49.7 ± 19.5 years), who received either central ECLS with (n = 20, 41.7%) or ECLS without (n = 28, 58.3%, including 10 peripheral ECLS) integrated left ventricular vent in our retrospective single centre trial. Results Follow up was 100% with a mean of 0.83 ± 1.85 years. Bridge to ventricular assist device was feasible in 29.2% (n = 14), bridge to transplant in 10.4% (n = 5) and bridge to recovery in 8.3% (n = 4). Overall 30-day survival was 37.5%, 6-month survival 27.1% and 1-year survival 25.0%. ECLS support with left ventricular decompression showed favourable 30-day survival compared to ECLS without left ventricular decompression (p = 0.034). Thirty-day as well as long-term survival did not differ between the subgroups (central ECLS with vent, ECLS without vent and peripheral ECLS without vent). Multivariate logistic regression adjusted for age and gender revealed ECLS without vent as independent factor influencing 30-day survival. Conclusion ECLS is an established therapy for patients in severe cardiogenic shock. Independent of the ECLS approach, 30-day mortality is still high but with superior 30-day survival for patients with ECLS and left ventricular venting. Moreover, by unloading the ventricle, left ventricular decompression may provide an important time window for recovery or further treatment, such as bridge to bridge or bridge to transplant.
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Affiliation(s)
- Bastian Schmack
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Seppelt
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany.,Medical Clinic III, Department of Cardiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, University Hospital Oldenburg, Oldenburg, Germany
| | - Christina Alt
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas O Doesch
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Philip W Raake
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Kallenbach
- Department of Cardiac Surgery, INCCI National Heart Institute, Luxembourg, Luxembourg
| | - Ashham Mansur
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen, Germany
| | - Aron-Frederik Popov
- Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Farag M, Badowski D, Koschny R, Skopp G, Brcic A, Szabo GB. Extracorporeal life support and digoxin-specific Fab fragments for successful management of Taxus baccata intoxication with low output and ventricular arrhythmia. Am J Emerg Med 2017; 35:1987.e3-1987.e7. [PMID: 28941873 DOI: 10.1016/j.ajem.2017.09.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 09/14/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Yew plants are evergreen shrubs which are widely spread throughout the northern hemisphere. Taxane alkaloid derivatives, mainly taxine B, represent the main toxins of Taxus baccata and are highly cardiotoxic. Due to the lack of randomized clinical trials, case reports on accidental or suicidal yew intoxications build the only source of knowledge of clinical treatment options. CASE REPORT We report the case of a suicidal yew ingestion admitted to our hospital under prolonged cardiopulmonary resuscitation due to pulseless electrical activity. Extra-corporeal life support (ECLS) was established to maintain adequate organ perfusion. Repeated administration of digoxin-specific Fab antibody fragments, which cross-react with taxine, was associated with an immediate conversion from asystole to broad-complex bradycardia and a gradual normalization of the electrocardiogram (ECG). This was paralleled by a recovery of the cardiac function and weaning from the ECLS. The taxine metabolite 3,5-dimethoxyphenol could be detected by mass spectrometry before but not after the first Fab-fragment treatment. In contrast, the total amount of taxine (including the neutralized, Fab fragment-bound fraction) was increased after each Fab fragment administration, suggesting an accumulation of neutralized, since antibody-bound taxine in the blood by anti-digoxin Fab fragments. DISCUSSION In conclusion, the successful clinical course of this case suggests a benefit of an early anti-digoxin Fab-fragment administration for the treatment of yew intoxication.
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Affiliation(s)
- Mina Farag
- Department of Cardiac Surgery, Heidelberg University Hospital, INF 110, 69120 Heidelberg, Germany.
| | - Dominika Badowski
- Department of Cardiac Surgery, Heidelberg University Hospital, INF 110, 69120 Heidelberg, Germany
| | - Ronald Koschny
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Intoxication, Heidelberg University Hospital, INF 410, 69120 Heidelberg, Germany
| | - Gisela Skopp
- Institute of Legal and Traffic Medicine, University Hospital Heidelberg, Vossstr. 2, 69115 Heidelberg, Germany
| | - Andreas Brcic
- Department of Anesthesiology, Heidelberg University Hospital, INF 110, 69120 Heidelberg, Germany
| | - Gabor B Szabo
- Department of Cardiac Surgery, Heidelberg University Hospital, INF 110, 69120 Heidelberg, Germany
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Spinthakis N, Farag M, Gorog D, Mahmood H, Prasad A, Srinivasan M. P1378Percutaneous coronary intervention with drug-eluting stent versus coronary artery bypass grafting: a meta-analysis of patients with left main coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Farag M, Borst T, Sabashnikov A, Zeriouh M, Schmack B, Arif R, Beller CJ, Popov AF, Kallenbach K, Ruhparwar A, Dohmen PM, Szabó G, Karck M, Weymann A. Surgery for Infective Endocarditis: Outcomes and Predictors of Mortality in 360 Consecutive Patients. Med Sci Monit 2017; 23:3617-3626. [PMID: 28740070 PMCID: PMC5539855 DOI: 10.12659/msm.902340] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A retrospective analysis was conducted of the early and long-term outcomes after surgery for infective endocarditis (IE). MATERIAL AND METHODS We included 360 patients with IE operated upon between 1993 and 2012. The primary endpoint was overall cumulative postoperative survival at 30 days. Secondary endpoints were early postoperative outcomes and complication rates. Factors associated with 30-day mortality were analyzed. RESULTS Mean age was 58.7±14.7 years and 26.9% (n=97) were female. The mean follow-up was 4.41±4.53 years. Postoperative survival was 81.7% at 30 days, 69.4% at 1 year, 63.3% at 5 years, and 63.3% at 10 years. Non-survivors were significantly older (p=0.014), with higher NYHA Class (p=0.002), had higher rates of preoperative diabetes mellitus (p=0.005), renal failure (p=0.001), and hepatic disease (p=0.002). Furthermore, non-survivors had higher baseline alanine aminotransferase (ALT, p=0.048), aspartate transaminase (AST, p=0.027), bilirubin (p=0.013), white cell count (WCC, p=0.034), and CRP (p=0.049). Factors associated with 30-day mortality were longer duration of surgery, CPB, and aortic cross-clamping times (p<0.001, p<0.001, and p=0.003, respectively), as well as higher RBC, FFP, and platelet transfusion requirements (p<0.001, p=0.005, and p<0.001, respectively). Multivariate logistic regression analysis revealed liver cirrhosis (OR 4.583, 95-CI: 1.096-19.170, p=0.037) and longer CPB time (OR 1.025, 95-CI 1.008-1.042, p=0.004) as independent predictors of 30-day mortality. CONCLUSIONS Surgical treatment of IE shows satisfactory early, midterm, and long-term results. Multivariate logistic regression analysis revealed cirrhosis and longer CPB time as independent predictors of 30-day mortality.
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Affiliation(s)
- Mina Farag
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Tobias Borst
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom.,Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Carsten J Beller
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Klaus Kallenbach
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany.,INCCI Haerzzenter, Luxembourg, Luxembourg
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Gábor Szabó
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany.,Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Affiliation(s)
- Mina Farag
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Marina Nikolic
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, University of Oldenburg, Oldenburg, Germany
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Saleeb R, Farag M, Brimo F, Rotondo F, Plant P, Yousef G. Abstract 2464: Papillary renal cell carcinoma, proposal of a new classification system based on integrated molecular, histological and clinical analysis. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2464] [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: 11/16/2022]
Abstract
Abstract
Background:
Papillary Renal Cell Carcinoma (PRCC) is divided into histological subtypes 1 and 2. Type 2 is known to have worse clinical behavior. A number of PRCC cases (~ 50%), fail to meet all reported morphological criteria for either type, hence are best characterized as PRCC not otherwise specified (NOS). There are yet no reliable markers to resolve the PRCC NOS category. That in turn reflects the clinical dilemma of how to manage these patients.
Experimental Design:
PRCC patient cohort of 115 cases was selected for the study. Cases were subtyped histologically into PRCC types 1, 2 and NOS. Potentially distinguishing markers ABCC2, CA9, SAll4, and BCL2 selected from our previous genomic analysis, were assessed by immunohistochemistry (IHC). A total of 24 cases were further selected for molecular analysis using miRNA expression and copy number variation (CNV). Univariate and multivariate survival analysis were performed using Log rank test and cox proportionate hazards.
Results:
Markers ABCC2, CA9 exhibited distinct staining patterns between the two classic PRCC subtypes; and successfully classified many of the PRCC NOS (45%) cases. Moreover, immunomarkers revealed a third distinct subtype of PRCC (35% of the PRCC cohort). Molecular
testing using miRNA expression and CNV analysis confirmed the presence of three distinct molecular signatures corresponding to the 3 subtypes. On univariate analysis DFS was significantly enhanced in the type1 versus 2& 3 (p value 0.047). PRCC subtyping retained
significance on multivariate analysis (p value 0.025, HR:6, 95% CI 1.25 to 32.2) .
Conclusion:
We propose a new classification system of PRCC integrating morphological, immunophenotypical, and molecular analysis. Our classification reveals a 3rd PRCC subtype that was not previously described. This subtype has overlapping morphology of with PRCC types 1 and 2, hence would be subtyped as PRCC NOS in the current classification. Molecularly PRCC type 3 has a distinct signature and clinically it behaves similar to PRCC type 2. The new classification stratifies PRCC patients into clinically relevant subgroups and has significant future implications on the management of PRCC.
Citation Format: Rola Saleeb, Mina Farag, Fadi Brimo, Fabio Rotondo, Pamela Plant, George Yousef. Papillary renal cell carcinoma, proposal of a new classification system based on integrated molecular, histological and clinical analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2464. doi:10.1158/1538-7445.AM2017-2464
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Affiliation(s)
- Rola Saleeb
- 1Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Mina Farag
- 1Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Fadi Brimo
- 2McGill University Health Center, Montreal, Quebec, Canada
| | - Fabio Rotondo
- 1Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Pamela Plant
- 1Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - George Yousef
- 1Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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Lichner Z, Saleeb R, Butz H, Nofech-Mozes R, Riad S, Farag M, Kapus A, Yousef G. Abstract 811: Histological heterogeneity contributes to sunitinib resistance in clear cell renal cell carcinoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-811] [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: 11/16/2022]
Abstract
Abstract
Introduction: The receptor tyrosine kinase (RTK) inhibitor sunitinib is the first line treatment for advanced clear cell renal cell carcinoma (ccRCC). Sunitinib inhibits angiogenesis via blocking signaling through VEGFR. About 80% of patients develop resistance after a drug-sensitive period. Molecular changes early in treatment may impact drug resistance, but are poorly understood.
Experimental Procedures: ACHN, 786-O and Renca cell lines were treated with 1 µM sunitinib. NSG mice were s.c. xenografted with the model cell lines and were treated with sunitinib at 40 mg/kg/day dose. mRNA expression was screened using Illumina HT-12 bead chip array and miRNA expression was assessed by Nanostring nCounter assay. R statistical packages were used for data processing. Reactome and miRPath softwares were used for downstream analysis.
Results: Sunitinib treatment of ccRCC xenografts led to several early changes in tumor histology, such as the emergence of live tumor areas within the necrotic spaces. These areas showed membranous staining for E-cadherin, and β-catenin, while the rest of the tumor and vehicle-treated tumors were negative. In vitro model cell lines developed cancer spheroids when treated with sunitinib. Cancer spheroids were highly tumorigenic and metastatic, and expressed several established cancer stem cell markers. ccRCC cancer spheres, but not the 2D adherent cells, showed membranous staining for E-cadherin and β-catenin; similarly to the live tumor areas observed in
in vivo sunitinib treatment. In vitro inhibition of E-cadherin by EGTA or by siRNA, interfered with viability of sunitinib treated ccRCC cell lines.
Conclusions: Sunitinib treatment causes early phenotypic changes of the tumor in vivo and in vitro. The formation of highly metastatic and tumorigenic cancer spheres in model cell lines is the most prominent effect in vitro. We provide preliminary evidence that sunitinib induced in vitro cancer spheres and the live tumor areas that survive within necrotic patches of the sunitinib-treated xenografts, are related. Finally, membranous expression of E-cadherin enhances the survival of ccRCC cell lines under sunitinib treatment.
Citation Format: Zsuzsanna Lichner, Rola Saleeb, Henriett Butz, Roy Nofech-Mozes, Sara Riad, Mina Farag, Andras Kapus, George Yousef. Histological heterogeneity contributes to sunitinib resistance in clear cell renal cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 811. doi:10.1158/1538-7445.AM2017-811
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Affiliation(s)
- Zsuzsanna Lichner
- Keenan Biomedical Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Rola Saleeb
- Keenan Biomedical Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Henriett Butz
- Keenan Biomedical Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Roy Nofech-Mozes
- Keenan Biomedical Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Sara Riad
- Keenan Biomedical Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Mina Farag
- Keenan Biomedical Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Andras Kapus
- Keenan Biomedical Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - George Yousef
- Keenan Biomedical Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
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Leidenberger T, Gordron Y, Farag M, Weis C, Müller-Eschner M, Delles M, Kallenbach K, Dillmann R, Kauczor H, Beller C, Rengier F. 4D-Fluss-MRT zur nichtinvasiven 4D-Blutdruckkartierung bei Patienten mit syndromalen Aneurysmen der Aortenwurzel. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Leidenberger
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - Y Gordron
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - M Farag
- Universitätsklinikum Heidelberg, Klinik für Herzchirurgie, Heidelberg
| | - C Weis
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - M Müller-Eschner
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - M Delles
- Karlsruher Institut für Technologie, Institut für Anthropomatik und Robotik, Karlsruhe
| | - K Kallenbach
- Universitätsklinikum Heidelberg, Klinik für Herzchirurgie, Heidelberg
| | - R Dillmann
- Karlsruher Institut für Technologie, Institut für Anthropomatik und Robotik, Karlsruhe
| | - H Kauczor
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - C Beller
- Universitätsklinikum Heidelberg, Klinik für Herzchirurgie, Heidelberg
| | - F Rengier
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
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Farag M, Arif R, Sabashnikov A, Zeriouh M, Popov AF, Ruhparwar A, Schmack B, Dohmen PM, Szabó G, Karck M, Weymann A. Repair or Replacement for Isolated Tricuspid Valve Pathology? Insights from a Surgical Analysis on Long-Term Survival. Med Sci Monit 2017; 23:1017-1025. [PMID: 28236633 PMCID: PMC5338566 DOI: 10.12659/msm.900841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Indexed: 11/27/2022] Open
Abstract
Background Long-term follow-up data concerning isolated tricuspid valve pathology after replacement or reconstruction is limited. Current American Heart Association guidelines equally recommend repair and replacement when surgical intervention is indicated. Our aim was to investigate and compare operative mortality and long-term survival in patients undergoing isolated tricuspid valve repair surgery versus replacement. Material/Methods Between 1995 and 2011, 109 consecutive patients underwent surgical correction of tricuspid valve pathology at our institution for varying structural pathologies. A total of 41 (37.6%) patients underwent tricuspid annuloplasty/repair (TAP) with or without ring implantation, while 68 (62.3%) patients received tricuspid valve replacement (TVR) of whom 36 (53%) were mechanical and 32 (47%) were biological prostheses. Results Early survival at 30 days after surgery was 97.6% in the TAP group and 91.1% in the TVR group. After 6 months, 89.1% in the TAP group and 87.8% in the TVR group were alive. In terms of long-term survival, there was no further mortality observed after one year post surgery in both groups (Log Rank p=0.919, Breslow p=0.834, Tarone-Ware p=0.880) in the Kaplan-Meier Survival analysis. The 1-, 5-, and 8-year survival rates were 85.8% for TAP and 87.8% for TVR group. Conclusions Surgical repair of the tricuspid valve does not show survival benefit when compared to replacement. Hence valve replacement should be considered generously in patients with reasonable suspicion that regurgitation after repair will reoccur.
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Affiliation(s)
- Mina Farag
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.,Department of Cardiothoracic Surgery, University of the Free State, Bloemfontein, South Africa
| | - Gábor Szabó
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany.,Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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76
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Arif R, Farag M, Zaradzki M, Reissfelder C, Pianka F, Bruckner T, Kremer J, Franz M, Ruhparwar A, Szabo G, Beller CJ, Karck M, Kallenbach K, Weymann A. Ischemic Colitis after Cardiac Surgery: Can We Foresee the Threat? PLoS One 2016; 11:e0167601. [PMID: 27977704 PMCID: PMC5157983 DOI: 10.1371/journal.pone.0167601] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 11/16/2016] [Indexed: 01/29/2023] Open
Abstract
Introduction Ischemic colitis (IC) remains a great threat after cardiac surgery with use of extracorporeal circulation. We aimed to identify predictive risk factors and influence of early catecholamine therapy for this disease. Methods We prospectively collected and analyzed data of 224 patients, who underwent laparotomy due to IC after initial cardiac surgery with use of extracorporeal circulation during 2002 and 2014. For further comparability 58 patients were identified, who underwent bypass surgery, aortic valve replacement or combination of both. Age ±5 years, sex, BMI ± 5, left ventricular function, peripheral arterial disease, diabetes and urgency status were used for match-pair analysis (1:1) to compare outcome and detect predictive risk factors. Highest catecholamine doses during 1 POD were compared for possible predictive potential. Results Patients’ baseline characteristics showed no significant differences. In-hospital mortality of the IC group with a mean age of 71 years (14% female) was significantly higher than the control group with a mean age of 70 (14% female) (67% vs. 16%, p<0.001). Despite significantly longer bypass time in the IC group (133 ± 68 vs. 101 ± 42, p = 0.003), cross-clamp time remained comparable (64 ± 33 vs. 56 ± 25 p = 0.150). The majority of the IC group suffered low-output syndrome (71% vs. 14%, p<0.001) leading to significant higher lactate values within first 24h after operation (55 ± 46 mg/dl vs. 31 ± 30 mg/dl, p = 0.002). Logistic regression revealed elevated lactate values to be significant predictor for colectomy during the postoperative course (HR 1.008, CI 95% 1.003–1.014, p = 0.003). However, Receiver Operating Characteristic Curve calculates a cut-off value for lactate of 22.5 mg/dl (sensitivity 73% and specificity 57%). Furthermore, multivariate analysis showed low-output syndrome (HR 4.301, CI 95% 2.108–8.776, p<0.001) and vasopressin therapy (HR 1.108, CI 95% 1.012–1.213, p = 0.027) significantly influencing necessity of laparotomy. Conclusion Patients who undergo laparotomy for IC after initial cardiac surgery have a substantial in-hospital mortality risk. Early postoperative catecholamine levels do not influence the development of an IC except vasopressin. Elevated lactate remains merely a vague predictive risk factor.
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Affiliation(s)
- Rawa Arif
- Department of Cardiac Surgery, Heart and Marfan Center—University of Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Mina Farag
- Department of Cardiac Surgery, Heart and Marfan Center—University of Heidelberg, Heidelberg, Germany
| | - Marcin Zaradzki
- Department of Cardiac Surgery, Heart and Marfan Center—University of Heidelberg, Heidelberg, Germany
| | - Christoph Reissfelder
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. Dresden, Germany
| | - Frank Pianka
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Jamila Kremer
- Department of Cardiac Surgery, Heart and Marfan Center—University of Heidelberg, Heidelberg, Germany
| | - Maximilian Franz
- Department of Cardiac Surgery, Heart and Marfan Center—University of Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart and Marfan Center—University of Heidelberg, Heidelberg, Germany
| | - Gabor Szabo
- Department of Cardiac Surgery, Heart and Marfan Center—University of Heidelberg, Heidelberg, Germany
| | - Carsten J. Beller
- Department of Cardiac Surgery, Heart and Marfan Center—University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center—University of Heidelberg, Heidelberg, Germany
| | - Klaus Kallenbach
- Department of Cardiac Surgery, HaerzZenter-INCCI, rue Ernest-Barblé, Luxembourg, Luxembourg
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center—University of Heidelberg, Heidelberg, Germany
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77
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Weymann A, Farag M, Sabashnikov A, Fatullayev J, Zeriouh M, Schmack B, Arif R, Müller F, Alt C, Raake P, Prakash Patil N, Popov AF, Rüdiger Simon A, Karck M, Ruhparwar A. Central Extracorporeal Life Support With Left Ventricular Decompression to Berlin Heart Excor: A Reliable “Bridge to Bridge” Strategy in Crash and Burn Patients. Artif Organs 2016; 41:519-528. [DOI: 10.1111/aor.12792] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/07/2016] [Accepted: 05/31/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Alexander Weymann
- Department of Cardiac Surgery; Heart and Marfan Center, University of Heidelberg; Heidelberg
| | - Mina Farag
- Department of Cardiac Surgery; Heart and Marfan Center, University of Heidelberg; Heidelberg
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery; Heart Center, University of Cologne; Cologne
| | - Javid Fatullayev
- Department of Cardiothoracic Surgery; Heart Center, University of Cologne; Cologne
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery; Heart Center, University of Cologne; Cologne
| | - Bastian Schmack
- Department of Cardiac Surgery; Heart and Marfan Center, University of Heidelberg; Heidelberg
| | - Rawa Arif
- Department of Cardiac Surgery; Heart and Marfan Center, University of Heidelberg; Heidelberg
| | - Florian Müller
- Department of Cardiac Surgery; Heart and Marfan Center, University of Heidelberg; Heidelberg
| | - Christina Alt
- Department of Cardiac Surgery; Heart and Marfan Center, University of Heidelberg; Heidelberg
| | - Philip Raake
- Department of Cardiology; University of Heidelberg; Heidelberg Germany
| | - Nikhil Prakash Patil
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust; Harefield Hospital; Harefield Middlesex United Kingdom
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust; Harefield Hospital; Harefield Middlesex United Kingdom
| | - Andre Rüdiger Simon
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust; Harefield Hospital; Harefield Middlesex United Kingdom
| | - Matthias Karck
- Department of Cardiac Surgery; Heart and Marfan Center, University of Heidelberg; Heidelberg
| | - Arjang Ruhparwar
- Department of Cardiac Surgery; Heart and Marfan Center, University of Heidelberg; Heidelberg
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Kremer J, Farag M, Arif R, Brcic A, Sabashnikov A, Schmack B, Popov AF, Karck M, Dohmen PM, Ruhparwar A, Weymann A. Total Artificial Heart Implantation After Undifferentiated High-Grade Sarcoma Excision. Med Sci Monit Basic Res 2016; 22:128-131. [PMID: 27803495 PMCID: PMC5103823 DOI: 10.12659/msmbr.901526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Indexed: 12/20/2022] Open
Abstract
Background Total artificial heart (TAH) implantation in patients with aggressive tumor infiltration of the heart can be challenging. Case Report We report on a patient with a rare primary undifferentiated high-grade spindle cell sarcoma of the mitral valve and in the left atrium, first diagnosed in 2014. The referring center did a first resection in 2014. In the course of 17 months, computer tomography (CT) scan again showed massive invasion of the mitral valve and left atrium. Partial resection and mitral valve replacement was not an option. We did a subtotal heart excision with total artificial heart implantation. In this report we discuss complications, risk factors, and perioperative management of this patient. Conclusions Patients with aggressive tumors of the heart can be considered for TAH implantation.
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Affiliation(s)
- Jamila Kremer
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Andreas Brcic
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Bastian Schmack
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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79
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Farag M, Patil NP, Sabashnikov A, Arif R, Szabó G, Kallenbach K, Ruhparwar A, Karck M, Brenner T, Hofer S, Weymann A. Comparison of Two Miniaturized Cardiopulmonary Bypass Systems Regarding Inflammatory Response. Artif Organs 2016; 41:139-145. [PMID: 27653813 DOI: 10.1111/aor.12750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 01/01/2016] [Revised: 02/27/2016] [Indexed: 11/30/2022]
Abstract
Cardiopulmonary bypass (CPB) is a known mediator of systemic inflammatory response. Extracorporeal circulations are undergoing continuous modifications and optimizations to achieve better results. Hence we aim to compare the inflammatory response associated with two recent miniature extracorporeal circulation systems during normothermic CPB. We measured plasma levels of cytokines including interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor-α, migration inhibitory factor (MIF), receptor for advanced glycation endproduct, and cluster of differentiation 40 ligand in 60 consecutive patients during the first 24 h after CPB. The patients were prospectively randomized to one of three trial groups: patients in group A were operated with the minimal extracorporeal circulation circuit (MECC, Maquet, Rastatt, Germany), group B operated with the extracorporeal circulation circuit optimized (ECC.O, Sorin, Italy), and group C operated with a conventional extracorporeal circuit (CECC, Maquet). Arterial blood samples were collected at intervals before, 30 min after initiation, and after termination of CPB. Further samples were collected 6 and 24 h after CPB. IL-10 levels were significantly raised in the CECC group as compared with either of the mini ECC-circuits with a peak concentration at 6 h postoperatively. Human MIF concentrations were significantly higher in the CECC group starting 30 min after CPB and peaking at the end of CPB. The overall reduction in cytokine concentrations in the mini-ECC groups correlated with a lower need for blood transfusion in MECC and a shorter mechanical ventilation time for ECC.O. Normothermic CPB using minimally invasive extracorporeal circulation circuits can reduce the inflammatory response as measured by cytokine levels, which may be beneficial for perioperative preservation of pulmonary function and hemostasis in low risk patients.
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Affiliation(s)
- Mina Farag
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Nikhil Prakash Patil
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, UK
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne
| | - Rawa Arif
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Gábor Szabó
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Klaus Kallenbach
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.,INCCI HAERZ ZENTER, Luxembourg
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Thorsten Brenner
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Hofer
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
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80
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Samak M, Fatullayev J, Sabashnikov A, Zeriouh M, Schmack B, Farag M, Popov AF, Dohmen PM, Choi YH, Wahlers T, Weymann A. Cardiac Hypertrophy: An Introduction to Molecular and Cellular Basis. Med Sci Monit Basic Res 2016; 22:75-9. [PMID: 27450399 PMCID: PMC4976758 DOI: 10.12659/msmbr.900437] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [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] [Indexed: 01/13/2023] Open
Abstract
Ventricular hypertrophy is an ominous escalation of hemodynamically stressful conditions such as hypertension and valve disease. The pathophysiology of hypertrophy is complex and multifactorial, as it touches on several cellular and molecular systems. Understanding the molecular background of cardiac hypertrophy is essential in order to protect the myocardium from pathological remodeling, or slow down the destined progression to heart failure. In this review we highlight the most important molecular aspects of cardiac hypertrophic growth in light of the currently available published research data.
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Affiliation(s)
- Mostafa Samak
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Javid Fatullayev
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Bastian Schmack
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Mina Farag
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Pascal M Dohmen
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
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81
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Schmack B, Weymann A, Popov AF, Patil NP, Sabashnikov A, Kremer J, Farag M, Brcic A, Lichtenstern C, Karck M, Ruhparwar A. Concurrent Left Ventricular Assist Device (LVAD) Implantation and Percutaneous Temporary RVAD Support via CardiacAssist Protek-Duo TandemHeart to Preempt Right Heart Failure. Med Sci Monit Basic Res 2016; 22:53-7. [PMID: 27145697 PMCID: PMC4913730 DOI: 10.12659/msmbr.898897] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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] [Indexed: 11/20/2022] Open
Abstract
Right ventricular failure (RVF) is an unfortunate complication that continues to limit outcomes following durable left ventricular assist device (LVAD) implantation. Despite several ‘RVF risk scores’ having been proposed, preoperative prediction of post-LVAD RVF remains a guesstimate at best. Current strategies for institution of temporary RVAD support are invasive, necessitate additional re-thoracotomy, restrict postoperative mobilization, and/or entail prolonged retention of prosthetic material in-situ. The authors propose a novel surgical strategy comprising simultaneous implantation of a permanent LVAD and percutaneous TandemHeart® plus ProtekDuo® to provide temporary RVAD support and preempt RVF in patients with impaired RV function.
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Affiliation(s)
- Bastian Schmack
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Nikhil Prakash Patil
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Jamila Kremer
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Brcic
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Matthias Karck
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
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82
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Arif R, Farag M, Gertner V, Szabó G, Weymann A, Veres G, Ruhparwar A, Bekeredjian R, Bruckner T, Karck M, Kallenbach K, Beller CJ. Female Gender and Differences in Outcome after Isolated Coronary Artery Bypass Graft Surgery: Does Age Play a Role? PLoS One 2016; 11:e0145371. [PMID: 26845158 PMCID: PMC4741386 DOI: 10.1371/journal.pone.0145371] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 12/01/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction Female gender is a known risk factor for early and late mortality after coronary artery bypass graft surgery (CABG). Higher age of women at operation may influence outcome, since age per se is also an important risk factor. The purpose of our study was to analyze possible gender differences in outcome after isolated CABG in different age groups to delineate the impact of female gender and age. Methods All patients over 60 years of age undergoing isolated CABG at our department during 2001 and 2011 were included and categorized by age into sexagenarians (2266, 16.6% women), septuagenarians (2332, 25.4% women) and octogenarians (374, 32% women) and assessed by gender for 30-day and 180-day mortality. Results Thirty-day mortality was significantly higher in women only amongst septuagenarians (7.1 vs. 4.7%, p = 0.033). Same differences apply for 180-day mortality (12.3 vs. 8.2%, p = 0.033) and estimated one-year survival (81.6 ± 4.2 vs. 86.9 ± 2.2%, p = 0.001). Predictive factors for 30-day mortality of septuagenarian were logistic EuroSCORE (ES) (p = 0.003), perioperative myocardial infarction (MI) (p<0.001), pneumonia (p<0.001), abnormal LV-function (p<0.04) and use of LIMA graft (p<0.001), but not female gender. However, female gender was found to be an independent predictor for 180-day mortality (HR 1.632, p = 0.001) in addition to ES, use of LIMA graft, perioperative MI, pneumonia and abnormal LV function (HR 1.013, p = 0.004; HR 0.523, p<0.001; HR 2.710, p<0.001; HR 3.238, p<0.001; HR 2.013, p<0.001). Conclusion Women have a higher observed probability of early death after CABG in septuagenarians. However, female gender was not found to be an independent risk factor for 30-day, but for 180-day survival. Therefore, reduction of high impact risk factors such as perioperative MI and enhancement of LIMA use should be future goals. In view of our findings, decision for surgical revascularization should not be based on gender.
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Affiliation(s)
- Rawa Arif
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Mina Farag
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Victor Gertner
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabor Szabó
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabor Veres
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Angiology and Pneumology, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Tom Bruckner
- Institute of Medical Biometry and Informatics, Heart Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Kallenbach
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten J. Beller
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
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83
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Weymann A, Farag M, Sabashnikov A, Fatullayev J, Schmack B, Arif R, Müller F, Möbius A, Raake P, Dösch A, Popov AF, Simon A, Beller C, Kallenbach K, Karck M, Ruhparwar A. Central ECLS with Left Ventricular Decompression to Berlin Heart Excor: a Reliable “Bridge to Bridge” Strategy in Crash and Burn Patients. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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84
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Zajonz D, Pfränger J, Fuchs J, Tiepolt S, Lindscheidt T, Farag M, Prietzel T. [Cardiac fibromyxosarcoma with bone metastases : palliative surgical treatment]. Orthopade 2014; 44:80-4. [PMID: 25465708 DOI: 10.1007/s00132-014-3034-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article presents the unusual case of a 58-year-old woman with a low-grade cardiac fibromyxosarcoma which was primarily surgically resected and treated with adjuvant chemotherapy. A pulmonary metastasis as well as osteolytic metastatic destruction of the right iliac crest occurred 3 years after primary diagnosis and 2 years later a bone metastasis of the left distal femur was detected. Applying a palliative treatment concept resection of the pulmonary metastasis and an extralesional resection of the bone metastasis of the right iliac crest with plastic reconstruction were performed. Afterwards resection of the left distal femur metastasis and prosthetic reconstruction with distal femur replacement could also be realized. Despite an initial poor prognosis a high quality of life without essential functional limitations could be maintained for more than 6 years in this individual case.
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Affiliation(s)
- D Zajonz
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
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85
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Beller C, Seppelt P, Farag M, Wannaku S, Karck M, Kallenbach K. 296 * GENDER-SPECIFIC DIFFERENCES IN OUTCOME OF ASCENDING AORTIC SURGERY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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86
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Arif R, Seppelt P, Farag M, Zaradzki M, Ruhparwar A, Karck M, Kallenbach K. 062 * PATIENTS WITH LUPUS ERYTHEMATODES AND ANTIPHOSPHOLIPID SYNDROME UNDERGOING CARDIAC VALVE SURGERY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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87
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Basyouni W, El-Bayouki K, El-Sayed A, Tohamy W, Farag M, Abd-El-Baseer M. 3,4,5-Trisubstituted Furan-2(5H)-one Derivatives: Efficient one-pot Synthesis and Evaluation of Cytotoxic Activity. Drug Res (Stuttg) 2014; 65:473-8. [DOI: 10.1055/s-0034-1387768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- W. Basyouni
- Organometallic and Organometalloid Chemistry Department, National Research Centre, Cairo, Egypt
| | - Kh. El-Bayouki
- Organometallic and Organometalloid Chemistry Department, National Research Centre, Cairo, Egypt
| | - A. El-Sayed
- Chemistry Department, Faculty of Science, Al-Azhar University, Cairo, Egypt
| | - W. Tohamy
- Organometallic and Organometalloid Chemistry Department, National Research Centre, Cairo, Egypt
| | - M. Farag
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, Egypt
| | - M. Abd-El-Baseer
- Center for Virus Research and Studies, Al-Azhar University, Cairo, Egypt
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88
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Prietzel T, Hammer N, Schleifenbaum S, Adler D, Pretzsch M, Köhler L, Petermann M, Farag M, Panzert S, Bauer S, von Salis-Soglio G. [The impact of capsular repair on the dislocation rate after primary total hip arthroplasty: a retrospective analysis of 1972 cases]. Z Orthop Unfall 2014; 152:130-43. [PMID: 24760453 DOI: 10.1055/s-0034-1368209] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Dislocation is the second most frequently encountered complication in primary total hip arthroplasty (THA) and occurs more commonly in the early postoperative rehabilitation phase. Sir Charnley recommended the "avoidance of resection of the capsule" and emphasised its contribution to hip joint stability in THA. Several authors, however, doubted its significance and considered resection of the capsule to be essential. Since 2002, some surgeons increasingly adopted a modified, less invasive technique of THA via Bauer approach, including the preservation and repair of the hip joint capsule with focus on maintaining its acetabular origin. Another group of surgeons applied the traditional technique including the resection of the joint capsule via an anterolateral approach. In this case-control study we investigated whether the dislocation rate can be reduced through joint capsule reconstruction and whether any negative impact on patient satisfaction, functional results or revision rate is observed. MATERIAL AND METHODS All cases of primary THA performed in our institution in a timeframe between 2002 and 2009 were included with the only exceptions of resurfacing arthroplasty, dual mobility and tumour hip replacements. Joint capsule repair cases were gathered in the study group (SG), capsule resection cases in the control group (CG). Additional patient-related data were taken from the anaesthesia records. The WOMAC score and a questionnaire focusing on detection of dislocations and revision surgeries was sent out for each case. Further targeted research was conducted that included requesting records and reports from external hospitals. In the case of non-responding patients, all available data (operating room documentation, electronic files, archive, X-rays) were reviewed for incidents of dislocation and revision surgery. Groupings and classifications were exclusively performed by senior surgeons. SG and CG were compared regarding epidemiologic, implant-associated and surgery-specific data. Statistical evaluations were performed using the Chi-squared test and the Mann-Whitney U test. RESULTS 1972 cases of primary THA were included: 992 in the SG and 980 in the CG. The follow-up rates were 92.7 % in the SG and 76.4 % in the CG, the mean follow-up times 33.5 months and 73.4 months, respectively, with a follow-up of at least 12 months in all cases. In the SG, the dislocation rate was 0.3 % (n = 3) and thus significantly lower than the 2.55 % in the CG (n = 25, p < 0.001). Both the WOMAC score (SG: 1.46 ± 1.73; CG: 1.53 ± 1.80; p > 0.05) and the revision rate (SG: 5.24 %; CG: 6.84 %; p = 0.139) showed no significant differences. CONCLUSION Preservation and repair of the hip joint capsule causes an 88-%-reduction of the dislocation rate in primary THA in this large series including 1972 cases, operated via the Bauer or the anterolateral approach. Several authors reported comparable results after THA using similar techniques of soft tissue and capsular repair through the posterior or posterolateral approach. Sparing and reconstructing the hip joint capsule therefore seems to reduce the dislocation rate after primary THA by one order of magnitude regardless of the surgical approach and, especially, if the acetabular origin is preserved. Capsule-related specific complications such as an increased revision rate, malfunction or pain were neither recorded in our study nor by others. Thus, careful preservation and reconstruction of the hip joint capsule may be expressly recommended in primary THA.
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Affiliation(s)
- T Prietzel
- Orthopädische Klinik und Poliklinik, Universität Leipzig
| | - N Hammer
- Institut für Anatomie, Universität Leipzig
| | - S Schleifenbaum
- Orthopädische Klinik und Poliklinik, Gelenkphysikalisches Labor, Universität Leipzig
| | - D Adler
- Orthopädische Klinik, Klinikum Ingolstadt
| | - M Pretzsch
- Klinik für Chirurgie, Abteilung Orthopädische Chirurgie, Helios Klinik Schkeuditz
| | - L Köhler
- Orthopädische Klinik und Poliklinik, Universität Leipzig
| | - M Petermann
- Orthopädisch-Traumatologisches Zentrum, Park-Krankenhaus Leipzig
| | - M Farag
- Klinik für Wirbelsäulenchirurgie und Querschnittsgelähmte, Zentralklinik Bad Berka
| | - S Panzert
- Orthopädische Klinik und Poliklinik, Universität Leipzig
| | - S Bauer
- Orthopädisch-Traumatologisches Zentrum, Park-Krankenhaus Leipzig
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89
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Ruhparwar A, Piontek P, Ungerer M, Ghodsizad A, Partovi S, Foroughi J, Szabo G, Farag M, Karck M, Spinks GM, Kim SJ. Electrically contractile polymers augment right ventricular output in the heart. Artif Organs 2014; 38:1034-9. [PMID: 24689769 DOI: 10.1111/aor.12300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 11/29/2022]
Abstract
Research into the development of artificial heart muscle has been limited to assembly of stem cell-derived cardiomyocytes seeded around a matrix, while nonbiological approaches to tissue engineering have rarely been explored. The aim of the study was to apply electrically contractile polymer-based actuators as cardiomyoplasty for positive inotropic support of the right ventricle. Complex trilayer polypyrrole (PPy) bending polymers for high-speed applications were generated. Bending motion occurred directly as a result of electrochemically driven charging and discharging of the PPy layers. In a rat model (n = 5), strips of polymers (3 × 20 mm) were attached and wrapped around the right ventricle (RV). RV pressure was continuously monitored invasively by direct RV cannulation. Electrical activation occurred simultaneously with either diastole (in order to evaluate the polymer's stand-alone contraction capacity; group 1) or systole (group 2). In group 1, the pressure generation capacity of the polymers was measured by determining the area under the pressure curve (area under curve, AUC). In group 2, the RV pressure AUC was measured in complexes directly preceding those with polymer contraction and compared to RV pressure complexes with simultaneous polymer contraction. In group 1, the AUC generated by polymer contraction was 2768 ± 875 U. In group 2, concomitant polymer contraction significantly increased AUC compared with complexes without polymer support (5987 ± 1334 U vs. 4318 ± 691 U, P ≤ 0.01). Electrically contractile polymers are able to significantly augment right ventricular contraction. This approach may open new perspectives for myocardial tissue engineering, possibly in combination with fetal or embryonic stem cell-derived cardiomyocytes.
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Affiliation(s)
- Arjang Ruhparwar
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
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90
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Beller C, Wannaku S, Farag M, Seppelt P, Zimmermann N, Karck M, Kallenbach K. Analysis of gender-specific differences in outcome of ascending aortic aneurysm surgery. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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91
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Arif R, Seppelt P, Zaradzki M, Farag M, Ruhparwar A, Karck M, Kallenbach K. Long-term outcome of patients with lupus erythematodes and Antiphospholipid Syndrome after cardiac valve surgery. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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92
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Mahe E, Farag M, Boutross-Tadross O. Invasive micropapillary breast carcinoma: a retrospective study of classification by pathological parameters. Malays J Pathol 2013; 35:133-138. [PMID: 24362476] [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: 06/03/2023]
Abstract
Micropapillary breast carcinoma has been recognized as a morphologically and biologically distinct form of breast carcinoma. Although data suggest that patient outcomes in cases of micropapillary breast carcinoma do not differ significantly from other breast carcinomas, the impact that a micropapillary component might have on the pathological work-up of a case of breast carcinoma remains an important point of discussion (especially as pertaining to the risk of lymphovascular disease). In this study, we perform an extensive retrospective study of the pathological parameters of seven years of breast surgical pathology cases to explore the relationship that micropapillary morphology might have with other important pathological parameters of a breast cancer case work-up (e.g. tumour size, lymphovascular invasion, lymph node status). We also analyze our data set to see if a micropapillary component would influence hierarchical classification by pathological parameters. Micropapillary features correlated with a higher frequency of ER positivity and lymphovascular invasion; there was no statistical difference between those cases with and without a micropapillary component from the perspective of other clinicopathological parameters, however. The presence of micropapillary features did influence classification, however, and produced a distinct cluster amidst comparison of other pathological variables.
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Affiliation(s)
- E Mahe
- University of Calgary, Faculty of Medicine, Department of Pathology & Laboratory Medicine, Calgary, AB, Canada
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93
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Farag M, Stern JS, Williams D, Grabecki K, Simmons H, Robertson MM. SERIAL DRUG USAGE FOR TICS IN TOURETTE SYNDROME - WHEN TO GIVE UP? Journal of Neurology, Neurosurgery & Psychiatry 2013. [DOI: 10.1136/jnnp-2013-306103.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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94
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Farag M, Weymann A, Schmack B, Rauch H, Karck M, Szabó G. Massive calcified tricuspid valve endocarditis in a patient with dual lumen tunneled venous catheter. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:730-3. [PMID: 23803532 DOI: 10.5761/atcs.cr.13.02275] [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: 11/16/2022] Open
Abstract
Infection is the most common cause of death in hemodialysis patients after cardiovascular complications. The long-term use of venous catheters for dialysis elevates the risk. Valvular calcification is of special concern in developing infective endocarditis and is often found in chronic dialysis patients. The right-sided endocarditis is rarely reported in the literature and may be overseen until the development of further complications. In our case tricuspid valve endocarditis, with severe insufficiency and stenosis due to a calcified laminar plate was found in a 57-year-old female patient undergoing dialysis due to end-stage renal disease. The calcification aroused from the tip of the dual lumen tunneled venous catheter used for routine dialysis. We replaced the tricuspid valve with mechanical valve prosthesis and reconstructed the right atrium.
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Affiliation(s)
- Mina Farag
- Department of Cardiac Surgery, Heart Center - University of Heidelberg, Heidelberg, Germany
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95
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Ghanem M, Farag M, Schneider P, Hitzler P, Gulow J, Freiherr von Salis-Soglio G. The short stem GHEs in total hip replacement - experience after 380 implantations. GMS Interdiscip Plast Reconstr Surg DGPW 2013; 2:Doc16. [PMID: 26504707 PMCID: PMC4582490 DOI: 10.3205/iprs000036] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Standard straight stems have been recognized as a gold standard implant in the field of hip replacement surgery. However, lately uncemented bone-preserving short stems started to gain more and more popularity. This was reflected in the increasing variety of available models. Up till now, short and mid-term results are available. Patients and methods: In 2002, the cementless short stemmed GHEs was introduced. 380 patients were included in our study between 2002 and 2008. Only GHEs short stems were implanted. The clinical and radiological evaluations were performed in the Orthopaedic Department, Leipzig University Hospitals, on the average of 24 months (3 to 60 months) postoperatively. Results: 365 primary implantations and 15 revision implantations were carried out. Average age 60 years. Favourable clinical and radiological outcome was seen in 361/380 patients (95%). Postoperative complications were seen in 19/380 patients (5%): 8 fissures/fractures (2.1%), 5 infections (1.3%), 4 aseptic loosenings (1.1%), 2 dislocations (0.5%). Conclusions: Short stem implants, including our own experience with GHEs model, are satisfying and promising. They represent a valuable supplementation of the treatment modalities in hip replacement surgery. However, long term results are still awaited.
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Affiliation(s)
- Mohamed Ghanem
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Leipzig, Leipzig, Germany
| | - M Farag
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Leipzig, Leipzig, Germany
| | - P Schneider
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Leipzig, Leipzig, Germany
| | - P Hitzler
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Leipzig, Leipzig, Germany
| | - J Gulow
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Leipzig, Leipzig, Germany
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96
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Kojic D, Ghodsizad A, Farag M, Sandrio S, Takahashi H, Arif R, Bordel V, Loebe M, Piontek P, Zugck C, Verch M, Kallenbach K, Karck M, Ruhparwar A, Ungerer M. The time of the tracheotomy in patients status post cardiac procedure has no significant impact on clinical outcome. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268983] [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]
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97
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Arif R, Ghodsizad A, Bordel V, Kim SH, Piontek P, Wiedensohler H, Kojic D, Loebe M, Farag M, Sandrio S, Takahashi H, Zugck C, Kallenbach K, Karck M, Ruhparwar A, Verch M, Ungerer M. Use of a new portable ultrasound device in the cardiothoracic intensive care unit: A performance review. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269320] [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]
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98
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Sandrio S, Farag M, Ghodsizad A, Ungerer M, Bordel V, Koch A, Arif R, Loebe M, Takahashi H, Gertner V, Piontek P, Kojic D, Zugck C, Kallenbach K, Karck M, Ruhparwar A. Once Daily Tacrolimus in the De-Novo prophylaxis of transplant rejection after orthotopic heart transplantation. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269254] [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]
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99
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Farag M, Ungerer M, Ghodsizad A, Bordel V, Piontek P, Loebe M, Arif R, Wiedensohler H, Kojic D, Zugck C, Kallenbach K, Karck M, Ruhparwar A, Tochtermann U. Reverse insertion of displaced JOTEC prosthesis in the frozen elephant trunk procedure: How to do it. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269369] [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]
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100
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Bordel V, Ghodsizad A, Ungerer M, Arif R, Sandrio S, Loebe M, Kojic D, Piontek P, Takahashi H, Farag M, Wiedensohler H, Zugck C, Kallenbach K, Karck M, Ruhparwar A. Application of the Organ Care System for extended transport of the donor heart and in-vitro coronary angiography. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269033] [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]
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