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Dong Z, Yao J, Li R, Liu X, Yuan F, Luo T, Zhang Q, Song G. Perioperative renal function change after transcatheter aortic valve replacement: A single-center retrospective study in China. Perfusion 2024; 39:759-765. [PMID: 36856783 DOI: 10.1177/02676591231158742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND In recent years, the kidney function after Transcatheter Aortic Valve Replacement (TAVR) has gradually become a hot spot that arouse extensive attention.Our study is aimed to evaluate the incidence and predictors of acute kidney recovery (AKR) after TAVR. METHODS A total of 102 patients undergoing TAVR in Beijing Anzhen Hospital from June 2021 to March 2022 were enrolled in our study. Patients were divided into AKR group (n = 54), unchanged group (n = 40) and acute kidney injury (AKI) group (n = 8) based on the percent change of estimated glomerular filtration rate (eGFR). Univariate analysis was used to compare the differences in general clinical characteristics and other related indicators between the three groups to analyze the risk factors of AKR. RESULTS The incidence of AKR was 53% (54/102) after TAVR. Multivariate analysis showed that the incidence of age and proportion of severe NYHA class (III or IV) was significantly higher in the AKR group while renal dysfunction (eGFR <60 mL/min/1.73 m2) was lower. Besides, fluid management/volume therapy was significantly different among the three groups. CONCLUSIONS AKR is a generalizable phenomenon occurring frequently after TAVR. The age, proportion of severe NYHA class and the baseline renal function are independent predictors of AKR events in patients with severe aortic stenosis undergoing TAVR.
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Affiliation(s)
- Zhe Dong
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Jing Yao
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui Li
- Department of Health Care, China-Japan Friendship Hospital, Beijing, China
| | - Xinmin Liu
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fei Yuan
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Taiyang Luo
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qian Zhang
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Lareyre F, Mialhe C, Bourlon F, Habib Y, Dommerc C, Raffort J. Diabetes mellitus is not associated with worse vascular outcome following percutaneous transfemoral transcatheter aortic valve implantation. Acta Cardiol 2019; 74:480-486. [PMID: 30642229 DOI: 10.1080/00015385.2018.1522074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/31/2022]
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an alternative to open surgical aortic valve replacement and the impact of diabetes on vascular outcomes is worth of investigation. The aim of our study was to determine if diabetic patients had distinct pre-operative characteristics compared to non-diabetics and to evaluate the impact of the disease on vascular outcomes.Methods: Four hundred consecutive patients who underwent TAVI with percutaneous transfemoral access were retrospectively included. Vascular outcomes were classified according to the Valve Academic Research Consortium 2 classification.Results: Seventy-eight (19.5%) patients were diabetics. Compared to non-diabetics, diabetic patients were younger and had significantly higher body mass index (29.7+/- 0.7 kg/m2 vs 26.8+/- 0.3, p < .0001), higher proportion of associated dyslipidemia (34.6% vs 11.5%, p < .0001) and arterial hypertension (60% vs 38.2%, p = .0009). Anatomical characteristics of the vascular access and procedural characteristics did not differ among the groups. No significant difference was observed in the incidence of major and minor vascular complications and 30-day post-operative mortality between diabetic and non-diabetic patients (2.6% vs 1.9%, p = .6916).Conclusion: Diabetes is not associated with worse vascular outcome following TAVI suggesting that the vascular access can be managed safely in these patients.
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Affiliation(s)
- Fabien Lareyre
- Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco, Monaco
- Université Côte d’Azur, Nice, France
| | - Claude Mialhe
- Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco, Monaco
| | - François Bourlon
- Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco, Monaco
| | - Yacoub Habib
- Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco, Monaco
| | - Carine Dommerc
- Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco, Monaco
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Tzamalis P, Herzberger V, Bergmann J, Wuerth A, Bramlage P, Schroefel H, Schmitt C, Schymik G. The association of diabetes mellitus treated with oral antidiabetic drugs and insulin with mortality after transcatheter valve implantation: a 3-year follow-up of the TAVIK registry. Cardiovasc Diabetol 2019; 18:63. [PMID: 31138207 PMCID: PMC6540569 DOI: 10.1186/s12933-019-0873-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) on insulin is a patient-related factor in the assessment of surgical risk based on the EuroSCORE II and, as such, it confers additional risk on outcomes after transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the effect of diabetes mellitus treated with insulin and oral antidiabetic drugs on clinical outcomes after TAVI. METHODS This study is an analysis of 2000 patients who underwent TAVI between 2008 and 2015. Patients were stratified post hoc into the following categories: without diabetes (n = 1337), with diabetes treated with oral antidiabetic drugs (OAD; n = 387) and with diabetes treated using insulin (n = 276). RESULTS There was no significant difference in device success (89.5% vs 89.4% vs 88.8%, adjusted odds ratio (adjOR) 1.10 [95% confidence interval (CI) 0.64-1.91]) and VARC-2-defined major complications among the three groups of patients (without DM, OAD, and insulin, respectively). Minor but not major or disabling strokes (adjOR 2.19; 95% CI 1.11-4.3) and overall renal complications (but not stage 2/3 alone) (adjOR 1.46; 95% CI 1.18-1.81) were more common in patients with diabetes than in those without diabetes. Insulin-treated patients had a significantly lower survival rate than that of patients with orally treated diabetes and of those without diabetes at 1 year (75.7% vs. 84.5% vs 84.7%, pairwise p < 0.01) and 3 years (56.9% vs. 65.9% vs. 67.9%, adj. p < 0.05) after TAVI. However, insulin-treated diabetes was not identified as an independent risk factor for higher mortality in the first (HR 1.29; 95% CI 0.97-1.72, p = 0.084) and 3rd years (HR 1.21; 95% CI 0.98-1.49; p = 0.079) after multivariable adjustment. CONCLUSIONS Although insulin-dependent DM is an established component of surgical risk assessment, it was not identified as an independent factor associated with reduced survival in TAVI. DM treated with oral antidiabetic drugs or insulin may have less role in decision making of treatment in TAVI candidates.
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Affiliation(s)
- Panagiotis Tzamalis
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany.
| | - Valentin Herzberger
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
| | - Jens Bergmann
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
| | - Alexander Wuerth
- Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Holger Schroefel
- Department Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Claus Schmitt
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
| | - Gerhard Schymik
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
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López-de-Andrés A, Perez-Farinos N, de Miguel-Díez J, Hernández-Barrera V, Méndez-Bailón M, de Miguel-Yanes JM, Jiménez-García R. Impact of type 2 diabetes mellitus in the utilization and in-hospital outcomes of surgical aortic valve replacement in Spain (2001-2015). Cardiovasc Diabetol 2018; 17:135. [PMID: 30326902 DOI: 10.1186/s12933-018-0780-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aims of this study were to examine trends in the incidence and in-hospital outcomes of SAVR among T2DM patients from 2001 to 2015, to compare clinical variables among T2DM patients and matched non-T2DM patients hospitalized for SAVR and to identify factors associated with in-hospital mortality (IHM) among T2DM patients. METHODS We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR as the procedure in their discharge report. For each T2DM patient, we selected a sex-, age-, implanted valve type- and year-matched nondiabetic patient. RESULTS We identified 78,223 patients who underwent SAVR (23.49% with T2DM). The prevalence of T2DM increased significantly (p < 0.001) from 16.7% in 2001-2003 to 23.5% in 2012-2015. The incidence of SAVR increased significantly from 28.99 cases in 2001 to 65.79 cases in 2015 per 100,000 individuals in the T2DM population. Using Poisson regression models, we found that the incidence of SAVR was 2.60 times higher among patients with T2DM than among those without diabetes (IRR 2.60; 95% CI 2.56-2.65). The incidence of mechanical SAVR among T2DM patients remained stable from 2001 to 2015, and bioprosthetic SAVR rose from 8.29 to 41.74 cases per 100,000 individuals in the T2DM patient population (p < 0.001). We matched 8835 and 9543 patients who underwent mechanical and bioprosthetic SAVR, respectively. IHM decreased over time in T2DM patients and non-T2DM patients (from 8.89% and 7.81% to 3.88% and 5.07%, respectively). IHM was significantly lower in T2DM patients than in nondiabetic subjects who underwent bioprosthetic SAVR (4.77% vs. 6.04%, p < 0.001), with similar results obtained for mechanical valves (7.11% and 7.77%). CONCLUSIONS The incidence of SAVR was higher in T2DM patients, and the incidence of bioprosthetic SAVR increased significantly among T2DM subjects. IHM decreased over time, regardless of the existence or absence of T2DM and the valve type. IHM was significantly lower in T2DM patients than in nondiabetic patients who underwent bioprosthetic SAVR.
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Mendez-Bailon M, Lorenzo-Villalba N, Muñoz-Rivas N, de Miguel-Yanes JM, De Miguel-Diez J, Comín-Colet J, Hernandez-Barrera V, Jimenez-Garcia R, Lopez-de-Andres A. Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014-2015). Cardiovasc Diabetol 2017; 16:144. [PMID: 29121921 PMCID: PMC5679322 DOI: 10.1186/s12933-017-0631-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/02/2017] [Indexed: 11/23/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is strongly related to the in-hospital and short-term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions. How T2DM might influence the treatment of aortic stenosis (AS) has not been completely elucidated for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). The aims of this study were: (1) to describe the use of aortic valve replacement procedures (TAVI and SAVR) among hospitalized patients with and without T2DM; and (2) to identify factors associated with in hospital mortality (IHM) among patients undergoing these procedures. Methods We analyzed data from the Spanish National Hospital Discharge Database between January 1, 2014 and December 31, 2015 for patients aged ≥ 40 years. We selected patients whose medical procedures included TAVI (ICD-9-CM codes 35.05, 35.06) and SAVR (ICD-9-CM codes 35.21, 35.22). We stratified each cohort by diabetes status: T2DM (ICD-9-CM codes 250.x0, 250.x2) and no diabetes. We retrieved data about specific comorbidities, risk factors, procedures, and specific in-hospital postoperative complications. Hospital outcome variables included IHM, and length of hospital stay (LOHS). Results We identified a total of 2141 and 16,013 patients who underwent TAVI (n = 715; 33.39% with T2DM) and SAVR (n = 4057; 25.33% with T2DM). In patients who underwent TAVI we found no differences in IHM (3.64% in T2DM vs. 5.12% in non-T2DM, p = 0.603). In the cohort of SAVR, mean LOHS was significantly lower in patients with T2DM than in non-diabetic patients (13.77 vs. 17.27 days). IHM was lower in patients with T2DM (4.36% vs. 6.31%, p < 0.01). After multivariable adjustment for both procedures, patients with T2DM had significantly lower IHM than patients without diabetes (adjusted OR 0.60; IC 95% 0.37–0.99 for TAVI and adjusted OR 0.80; IC 95% 0.66-0-96 for SAVR). Conclusions T2DM diabetic patients with AS undergoing a valvular replacement procedure through SAVR or TAVI did not have a worse prognosis compared to non-diabetic patients during hospitalization, showing lower IHM after multivariable adjustment. However, given the limitations of administrative data more prospective studies and clinical trials aimed at evaluating the influence of these procedures in diabetic patients with AS are needed. Electronic supplementary material The online version of this article (10.1186/s12933-017-0631-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuel Mendez-Bailon
- Internal Medicine Department, Instituto de Investigación Cardiovascular, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
| | - Noel Lorenzo-Villalba
- Service de Médicine Interne et Cancerlogie, Centre Hospitalier Saint Cyr, Lyon, France
| | - Nuria Muñoz-Rivas
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Javier De Miguel-Diez
- Pneumology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Josep Comín-Colet
- Department of Cardiology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
| | - Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
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Patris V, Giakoumidakis K, Argiriou M, Naka KK, Apostolakis E, Field M, Kuduvalli M, Oo A, Siminelakis S. Predictors of length of stay and duration of tracheal intubation after transcatheter aortic valve implantation. J Thorac Dis 2017; 9:1012-1022. [PMID: 28523156 DOI: 10.21037/jtd.2017.03.150] [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: 11/06/2022]
Abstract
BACKGROUND While short-term outcomes for patients undergoing transcatheter aortic valve implantation (TAVI) have long been studied, there is very little data on their predictors. We aimed to identify the predictors of outcomes, such as intensive care unit (ICU) and in-hospital length of stay (LOS), duration of postoperative intubation and in-hospital mortality, after TAVI procedures. METHODS We conducted a retrospective cohort study of 162 consecutive patients with aortic valve disease, who were admitted to a tertiary hospital of Liverpool for TAVI, during a five-year period. The data was collected using of the hospital's structured database on November 2014. RESULTS By using a multivariate analysis we found that any postoperative bleeding [odds ratio (OR) 2.71; 95% confidence interval (CI): 1.41-5.24] was the independent predictor of prolonged ICU-LOS, while older age (OR 1.11; 95% CI: 1.05-1.17) and transapical TAVI (OR 4.11; 95% CI: 1.94-8.71) were the predictors of prolonged in-hospital LOS. Additionally, patients treated with oral inotropic agents, preoperatively (OR 5.77; 95% CI: 2.21-15.01), non-diabetics (OR 3.07; 95% CI: 1.12-8.42) and those with any postoperative bleeding (OR 3.53; 95% CI: 1.68-7.43) had a significantly greater probability in remaining intubated postoperatively. The multivariate analysis did not reveal any predictor of in-hospital mortality. CONCLUSIONS The above predictors permit the early identification of TAVI patients at high risk for longer hospitalization and increased mechanical ventilation. This piece of information is crucial for clinicians and administrators contributing to more efficient patient care planning and better allocation of healthcare resources.
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Affiliation(s)
- Vasileios Patris
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | | | - Mihalis Argiriou
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Katerina K Naka
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Efstratios Apostolakis
- Department of Cardiothoracic Surgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Mark Field
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Aung Oo
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Stavros Siminelakis
- Department of Cardiothoracic Surgery, Medical School, University of Ioannina, Ioannina, Greece
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Berkovitch A, Segev A, Barbash I, Grossman Y, Maor E, Erez A, Regev E, Fink N, Mazin I, Hamdan A, Goldenberg I, Hay I, Spiegelstien D, Guetta V, Fefer P. Clinical impact of diabetes mellitus in patients undergoing transcatheter aortic valve replacement. Cardiovasc Diabetol 2015; 14:131. [PMID: 26427368 PMCID: PMC4591728 DOI: 10.1186/s12933-015-0291-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 06/20/2015] [Accepted: 09/15/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) and aortic stenosis (AS) are frequent findings in the elderly population. Data regarding the influence of DM on the outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) due to AS are limited. The aim of this study was to examine the impact of DM on TAVR outcomes. METHODS We investigated 443 patients with severe AS undergoing TAVR. Subjects were divided into insulin-dependent diabetic mellitus (IDDM) patients (N = 44), non-dependent insulin diabetic mellitus (NIDDM) patients (N = 114) and non-diabetics (N = 285) of whom 31 (74%), 86 (79%) and 209 (76%) respectively had trans-femoral TAVR. Peri-procedural complications and outcomes were recorded according to the Valve Academic Research Consortium-2 criteria. RESULTS Patients with IDDM as well as NIDDM demonstrated similar complication rates compared with non-diabetic patients, except for acute kidney injury (AKI) grade 3 [4 (2%) and 3 (3%) vs. 1 (0.4%) respectively, p = 0.032]. Kaplan-Meier survival analysis showed that DM, regardless of the type of treatment, was not associated with increased 2 years mortality (Log-rank p value 0.44). Multivariate cox regression analysis adjusted for age, gender, coronary artery disease, DM, AKI3, hypertension, chronic renal failure and peripheral vascular disease found that AKI3 was associated with increased risk of 2 years mortality [HR = 7.35, 95% CI 2.16-25.07, p = 0.001] whereas female gender was found as a protective factor [HR = 0.47, 95% CI 0.28-0.8, p = 0.005], and DM was not associated with increased risk. CONCLUSIONS Following TAVR, DM patients seem to have similar peri-procedural and mid-term outcomes compared with patients without DM, while IDDM patients seem to suffer greater incidence of AKI. Further research in larger cohorts of patients is needed to validate our results.
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Affiliation(s)
- Anat Berkovitch
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Department of Internal Medicine D, Chaim Sheba Medical Center, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Israel Barbash
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Yoni Grossman
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Department of Internal Medicine D, Chaim Sheba Medical Center, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Aharon Erez
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Ehud Regev
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Noam Fink
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Israel Mazin
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Ashraf Hamdan
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Ilan Hay
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Dan Spiegelstien
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Victor Guetta
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Paul Fefer
- Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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