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Reiter B, Tauber J, Naito S, Sill B, Zipfel S, Reichenspurner H. Critical Assessment of the Current German Healthcare Quality Assurance Program Using the Example of CABG. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Von Stumm M, Petersen J, Pausch J, Holst T, Gross TS, Sinn M, Reichenspurner H, Girdauskas E. Valvular Cardiomyopathy Persists Postoperatively in Aortic Regurgitation Patients: Data from cMRI-Based Cohort Study. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stolfa P, Petersen J, Alassar Y, Reichenspurner H, Pecha S. Predictors of Rhythm Outcome in Patients Undergoing Concomitant AF Ablation: A Single-Center Experience of More than 1,000 Patients. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bax L, Demal TJ, Onorati F, Nicolini F, Perrotti A, De Feo M, Santarpino G, Mariscalco G, Reichenspurner H, Biancari F. Acute Kidney Injury after Coronary Artery Bypass Grafting: A Risk Factor Analysis. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bhadra OD, Vitanova K, Saha S, Holzhey DM, Noack T, Kempfert J, Unbehaun A, Reichenspurner H, Bapat V, Tang GH, Conradi L. Outcome after Surgical TAVR Explantation: Insights from the International Multicenter EXPLANT-TAVR Registry. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pecha S, Yildirim Y, Petersen J, Tönnis T, Kirchhof P, Reichenspurner H. Minimally Invasive Epicardial Left-Ventricular Lead Implantation and Simultaneous Left Atrial Appendage Clipping. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pausch J, Bhadra OD, Mersmann J, Barten M, Tönnis T, Pecha S, Reichenspurner H, Bernhardt A. Prognostic Impact of Implantable Cardioverter Defibrillators in Patients with Continuous Flow Left Ventricular Assist Devices. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Beyer M, Blanke P, Modine T, Duncan A, Dumonteil N, Chuang ML, Lepsic J, Reichenspurner H, Conradi L. Cardiac Imaging to Screen Anatomical Suitability for Transapical Transcatheter Mitral Valve Implantation with a Tether-Based Device. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gebauer A, Constanze V, Schulte-Uentrop L, Barten M, Grahn H, Reichenspurner H, Bernhardt A. Extracorporeal Cytokine Hemoadsorption during Orthotopic Heart Transplantation: A Comparative Study. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ludwig S, Ben AW, Duncan A, Weimann J, Nickenig G, Hausleiter J, Baldus S, Ruge H, Von Bardeleben RS, Walther T, Bleiziffer S, Kempfert J, Granada J, Tang G, Blankenberg S, Reichenspurner H, Modine T, Conradi L. Characteristics and Outcomes of Patients Undergoing Screening for Transcatheter Mitral Valve Implantation: Results from the CHOICE-MI Registry. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Volgmann C, Gebauer A, Schulte-Uentrop L, Grahn H, Barten M, Reichenspurner H, Bernhardt A. Impact of Vasoplegic Syndrome on Early Clinical Outcome after Orthotopic Heart Transplantation. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bhadra OD, Kim WK, Reifart J, Veulemans V, Zeus T, Reichenspurner H, Gallo F, Giannini F, Conradi L. Impact of Horizontal Aorta in Self-Expanding TAVR Implantation: Insights from the HORSE International Multicenter Registry. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Reiter B, Zipfel S, Naito S, Tauber J, Reichenspurner H, Bernhardt A. Use of an Axillary-Implanted Transaortic Microaxial Left Ventricular Assist Device for Elective High-Risk OPCAB: Technique Description and Initial Experience. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sarwari H, Schäfer A, Reichenspurner H, Conradi L. Novel Percutaneous Plug-Based Vascular Closure Device for Minimally Invasive Valve Surgery: From Initial Experience to Routine Use. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yildirim Y, Yildirim S, Petersen J, Alassar Y, Sinning C, Conradi L, Reichenspurner H, Pecha S. Left-Atrial Strain Predicts Rhythm Outcome in Patients with Persistent Atrial Fibrillation Undergoing Left-Atrial Cryoablation during Minimally Invasive Endoscopic Mitral Valve Repair. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Petersen J, Meißner V, Wosgien K, Vettorazzi E, Blankenberg S, Conradi L, Girdauskas E, Reichenspurner H. Physical and Mental Recovery in Patients with Severe Aortic Valve Stenosis at Low-to-Intermediate Risk: SAVR versus TAVR. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Naito S, Demal TJ, Gatti G, Onorati F, Santini F, Reichenspurner H, Sill B, Biancari F. Impact of Off-Pump Coronary Bypass Surgery Experience on Early Postoperative Outcome Results from the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting). Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sarwari H, Bhadra O, Ludwig S, Schirmer J, Schofer N, Pecha S, Seiffert M, Blankenberg S, Reichenspurner H, Conradi L, Westermann D, Schäfer A. Transcatheter Aortic Valve Implantation after Previous Mitral Valve Repair or Replacement: Technical Considerations and Clinical Outcomes. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ludwig S, Ben AW, Duncan A, Weimann J, Nickenig G, Hausleiter J, Baldus S, Ruge H, Von Bardeleben RS, Walther T, Bleiziffer S, Kempfert J, Granada J, Tang G, Blankenberg S, Reichenspurner H, Modine T, Conradi L. 1-Year Outcomes after Transcatheter Mitral Valve Implantation: Results from the Global CHOICE-MI Registry. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Holst T, Petersen J, Waschki B, Sinning C, Rybczynski M, Reichenspurner H, Girdauskas E. Evaluation of Exercise Capacity after Aortic Valve Surgery for Aortic Regurgitation in Nonelderly Patients: Repair versus Replacement. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Grundmann D, Linder M, Gossling A, Voigtlaender L, Ludwig S, Waldschmidt L, Demal T, Bhadra O, Seiffert M, Schaefer A, Reichenspurner H, Blankenberg S, Westermann D, Conradi L, Schofer N. Diagnostic value and prognostic impact of various invasively derived hemodynamic parameters in patients with severe aortic stenosis undergoing TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ejection time (ET) and Acceleration time (AT) have been described as echocardiographic markers for aortic stenosis (AS).1 Moreover, in a recent study time between invasively measured left ventricular and aortic systolic pressure peaks (T-LVAo) was associated with anatomic AS severity.2 However, the diagnostic value of these parameters has not been validated in a larger patient cohort and their prognostic impact in AS patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown.
Purpose
We aimed to assess the diagnostic value and prognostic impact of ET, AT, and T-LVAo as assessed by invasive measurements in patients undergoing TAVI for severe AS.
Methods
This retrospective single-centre analysis studied 1478 patients undergoing TAVI from 2014 to 2019 for severe AS. All patients received echocardiographic, multislice computed tomography (MSCT) and invasive hemodynamic evaluation with simultaneous pressure measurements in left ventricle and aorta prior to TAVI. Anatomic AS severity was assessed according to MSCT-derived aortic valve calcification density (AVCd) defined as calcium volume per annulus area. All hemodynamic parameters were calculated offline using a dedicated software.
Results
Median patients' age was 81.2 (76.8–84.7) years and 807 (54.6%) were women. Predicted operative risk for mortality was 3.8 (2.6–5.7)% according to STS Score. Medians of invasively derived parameters were 70.0 ms (46.0–98.0) for T-LVAo, 308.0 ms (276.0–336.0) for ET, 180.0 ms (146.0–206.0) for AT. In spline analysis correlation of T-LVAo (Spearman: r=0.35; p<0.001) and ET (Spearman: r=0.18; p<0.001) with AVCd was significant but weak. AT showed negligible correlation with ACVd (Spearman: r=−0.05; p=0.089). The optimal cutoff for death (CD) according to C-statistic was 274 ms for ET and 158 ms for AT. Patients with ET or AT ≥ CD showed lower short and mid-term mortality rates compared to patients with ET or AT < CD (ET ≥ vs. < CD: mortality at 1-year: 14.5 vs. 31.9%, 3-years: 28.3 vs. 53.5%, all p<0.001; AT ≥ vs < CD: mortality at 1-year: 15.5 vs. 25.9%, p<0.001, 3-years: 34.0 vs. 41.0%, p=0.0032). Moreover, multivariate analysis for mortality identified ET (HR 0.58 [95% CI 0.43–0.77; p<0.001]) and AT (HR 0.65 [95% CI 0.49–0.86; p=0.0027]) to be associated with beneficial outcome after TAVI, independent from clinical risk factors and echocardiography-derived parameters like LVEF, mean gradient or stroke volume index. In contrast, T-LVAo showed no prognostic impact according to uni- or multivariate analyses.
Conclusion
T-LVAo provides the highest diagnostic value among the investigational hemodynamic parameters, however correlation with AVCd was weak. ET and AT are strong independent outcome predictors beyond clinical risk factors and standard echocardiographic parameters in AS patients following TAVI. Accordingly, use of ET and AT might improve risk assessment in patients scheduled for TAVI.
Funding Acknowledgement
Type of funding sources: None.
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Koell B, Ludwig S, Weimann J, Waldschmidt L, Schofer N, Seiffert M, Schirmer J, Westermann D, Reichenspurner H, Blankenberg S, Lubos E, Conradi L, Kalbacher D. Long-Term survival and functional status in patients with elevated mitral valve pressure gradient after transcatheter mitral valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A growing number of patients are currently treated for severe mitral regurgitation (MR) using a transcatheter mitral valve repair (TMVr). In clinical routine, the potential risk of elevated post-procedural mitral valve pressure gradient (MPG) may prohibit optimal MR reduction driven by the avoidance of additional clip implantations. Thus, the unfavorable impact on survival and functional outcome of increased MPG in patients undergoing TMVr is currently debatable.
Methods
In this single-center, prospective study, survival and functional outcome of 780 consecutive patients with severe MR undergoing TMVr between September 2008 and January 2020 were investigated. After exclusion of patients with unsuccessful procedure and those lost to follow-up, data of 676 patients with a median follow-up time of 5.26 (5.11, 5.51) years were analyzed. MPG was determined by transthoracic echocardiography at discharge and considered elevated in excess of 4.5 mmHg. Kaplan-Meier analysis as well as multivariable Cox regression models were performed for the impact on elevated MPG on 5-year outcomes for the subgroups of functional MR (FMR) and degenerative MR (DMR). The primary outcome measure was a combined endpoint of death or rehospitalization for congestive heart failure.
Results
Among 676 patients undergoing TMVr (mean age 74.6±8.5 years, 59.0% male, median STS Score 3.9 [interquartile range 2.5; 6.0]), 179 (26.4%) patients had elevated MPG >4.5 mmHg. FMR was present in 426 (63.0%) patients. In the overall patient cohort, Kaplan-Meier and Cox Regression analyses could not demonstrate significant differences for the combined endpoint (p=0.99). In contrast, subgroup analysis according to MR etiology indicated a significant adverse influence of elevated MPG on the combined endpoint as well as functional outcome in patients with DMR, but not with FMR (Figure 1). After adjustment, multivariate Cox Regression analysis showed an inferior prognosis in patients with DMR and elevated MVPG >4.5 mmHg (hazard ratio 1.79 [1.17, 2.72], p=0.0069, Figure 2).
Conclusions
TMVr-patients with DMR and measurable elevated post-procedural MVPG face an inferior prognosis and reduced functional outcomes compared to patients with FMR.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Sprenger J, Petersen J, Neumann N, Reichenspurner H, Russ D, Detter C, Schlaefer A. Tracking heart surface features to determine myocardial contrast agent enrichment. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2021. [DOI: 10.1515/cdbme-2021-1012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Fluorescent cardiac imaging can be applied for intraoperative quality control after a coronary bypass grafting surgery to ensure the myocardial perfusion by evaluating the increasing contrast agent enrichment in the heart. The motion due to the beating heart impedes the interpretation of the contrast agent enrichment in the vessels and leads to noisy enrichment curves. We propose tracking of the heart surface features to compensate for the motion of the beating heart and thereby improve the analysis of the contrast agent enrichment. Furthermore, we propose a vessel segmentation pipeline for a local evaluation of contrast agent enrichment directly in the vessels.
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Hu X, Deuse T, Gravina A, Wang D, Tediashvili G, Reichenspurner H, Davis M, Lanier L, Schrepfer S. CRIPSR/Cas9 Technology: Hypoimmunogenic Pluripotent Stem Cells Evade Immune Rejection in Fully Immunocompetent Allogeneic Recipients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Castro L, Zipfel S, Söffker G, Lubos E, Rybczniski M, Grahn H, Schrage B, Gebauer A, Barten M, Westermann D, Reichenspurner H, Bernhardt A. Switching to Impella 5.0 Decreases Need for Transfusion in Patients Undergoing Temporary Mechanical Circulatory Support. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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