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Horke A, Bobylev D, Avsar M, Cvitkovic T, Meyns B, Rega F, Hazekamp M, Cesnjevar R, Schmiady M, Staebler B, Dewald O, Ciubotaru A, Michel-Behnke I, Zimpfer D, Jashari R, Boethig D, Cebotari S, Beerbaum P, Tudorache I, Sarikouch S. Paediatric aortic valve replacement using decellularized allografts: a multicentre update following 143 implantations and five-year mean follow-up. Eur J Cardiothorac Surg 2024; 65:ezae112. [PMID: 38532286 PMCID: PMC11001491 DOI: 10.1093/ejcts/ezae112] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES Decellularized aortic homografts (DAH) were introduced in 2008 as a further option for paediatric aortic valve replacement (AVR). METHODS Prospective, multicentre follow-up of all paediatric patients receiving DAH for AVR in 8 European centres. RESULTS A total of 143 DAH were implanted between February 2008 and February 2023 in 137 children (106 male, 74%) with a median age of 10.8 years (interquartile range 6.6-14.6). Eighty-four (59%) had undergone previous cardiac operations and 24 (17%) had undergone previous AVR. The median implanted DAH diameter was 21 mm (interquartile range 19-23). The median operation duration was 348 min (227-439) with a median cardiopulmonary bypass time of 212 min (171-257) and a median cross-clamp time of 135 min (113-164). After a median follow-up of 5.3 years (3.3-7.2, max. 15.2 years), the primary efficacy end-points peak gradient (median 14 mmHg, 9-28) and regurgitation (median 0.5, interquartile range 0-1, grade 0-3) showed good results but an increase over time. Freedom from death/explantation/endocarditis/bleeding/thromboembolism at 5 years were 97.8 ± 1.2/88.7 ± 3.3/99.1 ± 0.9/100 and 99.2 ± 0.8%, respectively. Freedom from death/explantation/endocarditis/bleeding/thromboembolism at 10 years were 96.3 ± 1.9/67.1 ± 8.0/93.6 ± 3.9/98.6 ± 1.4 and 86.9 ± 11.6%, respectively. In total, 21 DAH were explanted. Seven were replaced by a mechanical AVR, 1 Ross operation was performed and a re-do DAH was implanted in 13 patients with no redo mortality. The calculated expected adverse events were lower for DAH compared to cryopreserved homograft patients (mean age 8.4 years), and in the same range as for Ross patients (9.2 years) and mechanical AVR (13.0 years). CONCLUSIONS This large-scale prospective analysis demonstrates excellent mid-term survival using DAH with adverse event rates comparable to paediatric Ross procedures.
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Affiliation(s)
- Alexander Horke
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tomislav Cvitkovic
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bart Meyns
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Belgium
| | - Mark Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Netherlands
| | - Robert Cesnjevar
- Division of Congenital Cardiovascular Surgery, University Children’s Hospital, Zurich, Switzerland
| | - Martin Schmiady
- Division of Congenital Cardiovascular Surgery, University Children’s Hospital, Zurich, Switzerland
| | - Brigitte Staebler
- Department of Cardiac Surgery, Sana Herzchirurgie, Stuttgart, Germany
| | - Oliver Dewald
- Division of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Anatol Ciubotaru
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Ina Michel-Behnke
- Department of Pediatric Cardiology, Medical University of Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Ramadan Jashari
- European Homograft Bank, Clinique Saint-Jean, Brussels, Belgium
| | - Dietmar Boethig
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Germany
| | - Serghei Cebotari
- Department of Cardiac Surgery, Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg, Luxembourg
| | - Philipp Beerbaum
- Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Germany
| | - Igor Tudorache
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Clinic for Cardiac Surgery, University Heart Center Zurich, Zurich, Switzerland
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Horke A, Tudorache I, Laufer G, Andreas M, Pomar JL, Pereda D, Quintana E, Sitges M, Meyns B, Rega F, Hazekamp M, Cesnjevar R, Schmiady MO, Pepper J, Rosendahl U, Lichtenberg A, Stadnik D, Jashari R, Boethig D, Bobylev D, Avsar M, Ruhparwar A, Haverich A, Cebotari S, Sarikouch S. Five-year results from a prospective, single-arm European trial on decellularized allografts for aortic valve replacement-the ARISE Study and ARISE Registry Data. Eur J Cardiothorac Surg 2024; 65:ezae121. [PMID: 38532304 PMCID: PMC11009017 DOI: 10.1093/ejcts/ezae121] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES Decellularized aortic homografts (DAH) were introduced as a new option for aortic valve replacement for young patients. METHODS A prospective, EU-funded, single-arm, multicentre study in 8 centres evaluating non-cryopreserved DAH for aortic valve replacement. RESULTS A total of 144 patients (99 male) were prospectively enrolled in the ARISE Trial between October 2015 and October 2018 with a median age of 30.4 years [interquartile range (IQR) 15.9-55.1]; 45% had undergone previous cardiac operations, with 19% having 2 or more previous procedures. The mean implanted DAH diameter was 22.6 mm (standard deviation 2.4). The median operation duration was 312 min (IQR 234-417), the median cardiopulmonary bypass time was 154 min (IQR 118-212) and the median cross-clamp time 121 min (IQR 93-150). No postoperative bypass grafting or renal replacement therapy were required. Two early deaths occurred, 1 due to a LCA thrombus on day 3 and 1 due ventricular arrhythmia 5 h postoperation. There were 3 late deaths, 1 death due to endocarditis 4 months postoperatively and 2 unrelated deaths after 5 and 7 years due to cancer and Morbus Wegener resulting in a total mortality of 3.47%. After a median follow-up of 5.9 years [IQR 5.1-6.4, mean 5.5 years. (standard deviation 1.3) max. 7.6 years], the primary efficacy end-points peak gradient with median 11.0 mmHg (IQR 7.8-17.6) and regurgitation of median 0.5 (IQR 0-0.5) of grade 0-3 were excellent. At 5 years, freedom from death/reoperation/endocarditis/bleeding/thromboembolism were 97.9%/93.5%/96.4%/99.2%/99.3%, respectively. CONCLUSIONS The 5-year results of the prospective multicentre ARISE trial continue to show DAH to be safe for aortic valve replacement with excellent haemodynamics.
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Affiliation(s)
- Alexander Horke
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Clinic for Cardiac Surgery, University Heart Center Zurich, Zurich, Switzerland
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Jose Luis Pomar
- Department of Cardiovascular Surgery, Hospital Clinico de Barcelona, Barcelona, Spain
| | - Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clinico de Barcelona, Barcelona, Spain
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinico de Barcelona, Barcelona, Spain
| | - Marta Sitges
- Department of Cardiology, Hospital Clinico de Barcelona, Barcelona, Spain
| | - Bart Meyns
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mark Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robert Cesnjevar
- Division of Congenital Cardiovascular Surgery, University Children’s Hospital, Zurich, Switzerland
| | - Martin Oliver Schmiady
- Clinic for Cardiac Surgery, University Heart Center Zurich, Zurich, Switzerland
- Division of Congenital Cardiovascular Surgery, University Children’s Hospital, Zurich, Switzerland
| | - John Pepper
- Department of Cardiovascular Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ulrich Rosendahl
- Department of Cardiovascular Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Artur Lichtenberg
- Department for Cardiac Surgery, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Dmytro Stadnik
- Department for Cardiac Surgery, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ramadan Jashari
- European Homograft Bank, Clinique Saint-Jean, Bruessels, Belgium
| | - Dietmar Boethig
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiac Surgery, Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg, Luxembourg
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Franz M, Tavil S, de Manna ND, Aburahma K, Boethig D, Bobylev D, Welte T, Greer M, Schwerk N, Ruhparwar A, Kuehn C, Salman J, Ius F. Oversizing lung allografts deteriorates outcomes in patients with pulmonary fibrosis. J Heart Lung Transplant 2024:S1053-2498(24)01516-X. [PMID: 38438087 DOI: 10.1016/j.healun.2024.02.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/02/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Lung transplantation is the only curative treatment for patients with end-stage pulmonary fibrosis. Due to the shortage of donor organs most lung allografts are either oversized or undersized. It is still under debate whether over- or undersizing is preferably performed regarding the postoperative outcome. We therefore analysed our data using predicted total lung capacity to compare size-mismatches. METHODS Patient records were retrospectively reviewed. Three groups were formed, one including patients with a donor-recipients pTLC-ratio (DRPR) of <1.0 (undersized group), the second with a DRPR of ≥1.0 and <1.1 (size matched group) and the third group with a DRPR of ≥1.1 (oversized group). Outcomes were evaluated using Chi-Square test and Kruskall-Wallis test as well as Kaplan-Meier analysis, competing risk analysis and multivariable analysis, respectively. RESULTS Between January 2010 and May 2023, among the 1501 patients transplanted at our institution, 422 (28%) patients were included, 26 (2%) patients forming the oversized group (median DRPR: 1.14), 101 (7%) patients forming the size matched group (median DRPR: 1.03) and 296 (20%) patients forming the undersized group (median DRPR: 0.92). Patients from the oversized group had a higher PGD grade 3 rate at 24 (p<0.001), 48 (p<0.001) and 72 (p=0.039) hours after transplantation as well as a higher in-hospital mortality compared to the undersized group (p=0.033). The long-term survival was also better in the undersized group compared to the oversized group (p=0.011) and to the size matched group (p=0.01). CONCLUSION Oversizing lung allografts more than 10% deteriorated early postoperative outcomes and long-term survival in patients with pulmonary fibrosis.
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Affiliation(s)
- Maximilian Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Saleh Tavil
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nunzio Davide de Manna
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Nicolaus Schwerk
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
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Bobylev D, Horke A, Avsar M, Cvitkovic T, Boethig D, Hazekamp M, Meyns B, Rega F, Dave H, Schmiady M, Ciubotaru A, Cheptanaru E, Vida V, Padalino M, Tsang V, Jashari R, Laufer G, Andreas M, Andreeva A, Tudorache I, Cebotari S, Haverich A, Sarikouch S. Matched comparison of decellularized homografts and bovine jugular vein conduits for pulmonary valve replacement in congenital heart disease. Cell Tissue Bank 2024; 25:55-66. [PMID: 36917328 PMCID: PMC10901942 DOI: 10.1007/s10561-023-10082-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
For decades, bovine jugular vein conduits (BJV) and classic cryopreserved homografts have been the two most widely used options for pulmonary valve replacement (PVR) in congenital heart disease. More recently, decellularized pulmonary homografts (DPH) have provided an alternative avenue for PVR. Matched comparison of patients who received DPH for PVR with patients who received bovine jugular vein conduits (BJV) considering patient age group, type of heart defect, and previous procedures. 319 DPH patients were matched to 319 BJV patients; the mean age of BJV patients was 15.3 (SD 9.5) years versus 19.1 (12.4) years in DPH patients (p = 0.001). The mean conduit diameter was 24.5 (3.5) mm for DPH and 20.3 (2.5) mm for BJV (p < 0.001). There was no difference in survival rates between the two groups after 10 years (97.0 vs. 98.1%, p = 0.45). The rate of freedom from endocarditis was significantly lower for BJV patients (87.1 vs. 96.5%, p = 0.006). Freedom from explantation was significantly lower for BJV at 10 years (81.7 vs. 95.5%, p = 0.001) as well as freedom from any significant degeneration at 10 years (39.6 vs. 65.4%, p < 0.001). 140 Patients, matched for age, heart defect type, prior procedures, and conduit sizes of 20-22 mm (± 2 mm), were compared separately; mean age BJV 8.7 (4.9) and DPH 9.5 (7.3) years (p = n.s.). DPH showed 20% higher freedom from explantation and degeneration in this subgroup (p = 0.232). Decellularized pulmonary homografts exhibit superior 10-year results to bovine jugular vein conduits in PVR.
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Affiliation(s)
- Dmitry Bobylev
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tomislav Cvitkovic
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Hazekamp
- Department of Congenital Cardiac Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart Meyns
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hitendu Dave
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Martin Schmiady
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Anatol Ciubotaru
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Eduard Cheptanaru
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Azienda Ospedaliera di Padova, University of Padua Medical School, Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Azienda Ospedaliera di Padova, University of Padua Medical School, Padua, Italy
| | - Victor Tsang
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Ramadan Jashari
- European Homograft Bank, Clinique Saint-Jean, Brussels, Belgium
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexandra Andreeva
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Igor Tudorache
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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Jack T, Carlens J, Diekmann F, Hasan H, Chouvarine P, Schwerk N, Müller C, Wieland I, Tudorache I, Warnecke G, Avsar M, Horke A, Ius F, Bobylev D, Hansmann G. Bilateral lung transplantation for pediatric pulmonary arterial hypertension: perioperative management and one-year follow-up. Front Cardiovasc Med 2023; 10:1193326. [PMID: 37441704 PMCID: PMC10333590 DOI: 10.3389/fcvm.2023.1193326] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023] Open
Abstract
Background Bilateral lung transplantation (LuTx) remains the only established treatment for children with end-stage pulmonary arterial hypertension (PAH). Although PAH is the second most common indication for LuTx, little is known about optimal perioperative management and midterm clinical outcomes. Methods Prospective observational study on consecutive children with PAH who underwent LuTx with scheduled postoperative VA-ECMO support at Hannover Medical School from December 2013 to June 2020. Results Twelve patients with PAH underwent LuTx (mean age 11.9 years; age range 1.9-17.8). Underlying diagnoses included idiopathic (n = 4) or heritable PAH (n = 4), PAH associated with congenital heart disease (n = 2), pulmonary veno-occlusive disease (n = 1), and pulmonary capillary hemangiomatosis (n = 1). The mean waiting time was 58.5 days (range 1-220d). Three patients were bridged to LuTx on VA-ECMO. Intraoperative VA-ECMO/cardiopulmonary bypass was applied and VA-ECMO was continued postoperatively in all patients (mean ECMO-duration 185 h; range 73-363 h; early extubation). The median postoperative ventilation time was 28 h (range 17-145 h). Echocardiographic conventional and strain analysis showed that 12 months after LuTx, all patients had normal biventricular systolic function. All PAH patients are alive 2 years after LuTx (median follow-up 53 months, range 26-104 months). Conclusion LuTx in children with end-stage PAH resulted in excellent midterm outcomes (100% survival 2 years post-LuTx). Postoperative VA-ECMO facilitates early extubation with rapid gain of allograft function and sustained biventricular reverse-remodeling and systolic function after RV pressure unloading and LV volume loading.
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Affiliation(s)
- Thomas Jack
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Julia Carlens
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Franziska Diekmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Hosan Hasan
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Philippe Chouvarine
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Nicolaus Schwerk
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Carsten Müller
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Ivonne Wieland
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Gregor Warnecke
- Department of Cardiac Surgery, Ruprecht-Karls-University, Heidelberg, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
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Aburahma K, de Manna ND, Boethig D, Franz M, Iablonskii P, Heise EL, Bobylev D, Avsar M, Greer M, Schwerk N, Sommer W, Welte T, Haverich A, Warnecke G, Kuehn C, Salman J, Ius F. Impact of Total Ischemic Time and Disease Severity Class on Graft Function after Bilateral Lung Transplantation. Eur J Cardiothorac Surg 2023:7160914. [PMID: 37171893 DOI: 10.1093/ejcts/ezad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/10/2023] [Accepted: 05/11/2023] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVES Total ischemic time is considered a limiting factor in lung transplantation. In this retrospective study we investigate effects of ischemic time and disease burden on outcomes after bilateral lung transplantation. METHODS 1,298 patients undergoing bilateral lung transplantation between January 2010 and May 2022 (Follow-up 100%, median 54 months) were included. Pre-transplant diseases 'severity (recipient body mass index, recipient age, previous lung transplantation, Tacrolimus immunosuppression, preoperative recipient extracorporeal membrane oxygenation support, lung volume reduction) for graft failure was individually calculated and- as ischemic time- categorised. Vice-versa adjusted Cox models were calculated. Considering competing risks, we assessed cumulative incidences of airway obstructive complications and chronic lung allograft dysfunction with death as competing risk factors for primary graft dysfunction were assessed by binary logistic regression. RESULTS Higher disease burden significantly accelerated chronic lung allograft dysfunction and death occurrence (p < 0.001); ischemic time did not. Ischemic time adjusted disease burden strata showed 50% graft survival differences at 11 years after transplantation (range 24-74%), disease burden adjusted ischemic time strata 18% for all and 6% (54-60%) among those above 7 hours. All significant primary graft dysfunction risk factors were diagnoses related, ischemic time was not significantly important, and odds ratios did not increase with ischemic time. CONCLUSION The eventual graft survival disadvantage that results from an ischemic time between 7 and at least 11 hours is negligible in contrast to frequent recipients' disease-based risk levels.
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Affiliation(s)
- Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nunzio D de Manna
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Maximilian Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Pavel Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Emma L Heise
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Paediatrics, Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
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Franz M, Aburahma K, Avsar M, Bobylev D, Sommer W, Greer M, Tudorache I, Welte T, Haverich A, Warnecke G, Kuehn C, Ius F, Salman J. Does Donor-Recipient Sex Mismatch Have an Influence on Long Term Outcomes after Lung Transplantation? An Experience of a High Volume Center. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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8
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Franz M, Aburahma K, Yablonski P, Carlens J, Saipbaev A, Mueller C, Sommer W, Kuehn C, Haverich A, Warnecke G, Avsar M, Schwerk N, Salman J, Bobylev D, Ius F. Nine-Year Experience with Treatment of Early Detectable Donor Specific Anti-HLA Antibodies in Pediatric Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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9
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Heise E, Chichelnitskiy E, Franz M, Aburahma K, Iablonski P, Bobylev D, Saipbaev A, Schwerk N, Sommer W, Greer M, Avsar M, Wiegmann B, Knöfel A, Kühne J, Warnecke G, Haverich A, Kühn C, Salman J, Falk C, Ius F. Perioperative Desensitization Changes the Plasma Cytokine Milieu in Lung Transplant Patients with Preformed Donor Specific Antibodies. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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10
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Floethmann K, Aburahma K, de Manna N, Franz M, Yablonski P, Saipbaev A, Greer M, Avsar M, Bobylev D, Schwerk N, Sommer W, Warnecke G, Welte T, Haverich A, Kuehn C, Salman J, Ius F. Impact of Donor Quality on Recipient Outcomes in Lung Transplantation: 12-Year Single-Center Experience Using the Eurotransplant Lung Donor Score. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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11
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Franz M, Aburahma K, Avsar M, Bobylev D, Sommer W, Greer M, Tudorache I, Welte T, Haverich A, Warnecke G, Kuehn C, Ius F, Salman J. 12-Year Experience with Postoperatively Extended Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation for Patients with Severe Pulmonary Arterial Hypertension. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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12
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Bobylev D, Hysko K, Avsar M, Cvitkovic T, Petena E, Sarikouch S, Westhoff-Bleck M, Hansmann G, Haverich A, Horke A. Simultaneous aortic and pulmonary valve replacement in repaired congenital heart disease. Thorac Cardiovasc Surg 2023. [PMID: 36822229 DOI: 10.1055/a-2041-3528] [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: 02/25/2023]
Abstract
OBJECTIVES Patients with congenital heart disease frequently require surgical or percutaneous interventional valve replacement after initial CHD repair. In some of these patients, simultaneous replacement of both semilunar valves is necessary, resulting in increased procedural complexity, morbidity, and mortality. In this study, we analyze the outcomes of simultaneous aortic and pulmonary valve replacements following multiple surgical interventions for CHD. METHODS A retrospective study of 24 patients who after initial repair of CHD underwent single-stage aortic and pulmonary valve replacement at our institution between 2003 - 2021. RESULTS The mean age of the patients was 28±13 years; the mean time since the last surgery was 15±11years. Decellularized valved homografts (DVH) were used in 9 patients and mechanical valves were implanted in 7 others. In 8 patients, DVHs, biological, and mechanical valves were implanted in various combinations. The mean cardio-pulmonary bypass time was 303±104min and aortic cross-clamp time was 152±73min. Two patients died at 12 and 16 days postoperatively. At a maximum follow-up time of 17 years (mean 7±5years), 95% of the surviving patients were categorized as NYHA heart failure class I. CONCLUSIONS Single-stage aortic and pulmonary valve replacement after initial repair of CHD remains challenging with substantial perioperative mortality (8.3%). Nevertheless, long-term survival and clinical status at the latest follow-up were excellent. The valve type had no relevant impact on the postoperative course. The selection of the valves for implantation should take into account operation-specific factors - in particular re-operability - as well as the patients' wishes.
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Affiliation(s)
| | - Klea Hysko
- Hannover Medical School, Hannover, Germany
| | | | | | | | - Samir Sarikouch
- Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | | | - Axel Haverich
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Cardiac Surgery, Medizinische Hochschule Hannover Klinikum, Hannover, Germany
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Hysko K, Hohmann D, Bobylev D, Horke A, Bertram H, Happel C, Hansmann G. Interventional Balloon Dilation/Stenting Is as Effective as Surgery in Improving Biventricular Performance in Neonates with Isolated Coarctation of the Aorta. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761828] [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: 03/22/2023]
Affiliation(s)
- K. Hysko
- Department of Pediatric Cardiology, Hannover Medical School, Hanover, Deutschland
| | - D. Hohmann
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - D. Bobylev
- Carl-Neuberg-Straße 1, Hannover, Deutschland
| | - A. Horke
- Carl-Neuberg-Straße 1, Hannover, Deutschland
| | - H. Bertram
- Carl-Neuberg-Straße 1, Hannover, Deutschland
| | - C. Happel
- Department of Pediatric Cardiology, Hannover Medical School, Hanover, Deutschland
| | - G. Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Deutschland
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Aburahma K, Franz M, Julia C, Heise E, Saipbaev A, Mueller C, Kühn C, Haverich A, Warnecke G, Avsar M, Schwerk N, Salman J, Bobylev D, Ius F. Nine-Year Experience with Treatment of Early Donor Specific Anti-HLA Antibodies in Pediatric Lung Transplant Recipients. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761791] [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: 03/22/2023]
Affiliation(s)
- K. Aburahma
- Hannover Medical School, Hannover, Deutschland
| | - M. Franz
- Hannover Medical School, Hannover, Deutschland
| | - C. Julia
- Hannover Medical School, Hannover, Deutschland
| | - E. Heise
- Hannover Medical School, Hannover, Deutschland
| | - A. Saipbaev
- Hannover Medical School, Hannover, Deutschland
| | - C. Mueller
- Hannover Medical School, Hannover, Deutschland
| | - C. Kühn
- Hannover Medical School, Hannover, Deutschland
| | - A. Haverich
- Hannover Medical School, Hannover, Deutschland
| | - G. Warnecke
- University Hospital Heidelberg, Heidelberg, Deutschland
| | - M. Avsar
- Hannover Medical School, Hannover, Deutschland
| | - N. Schwerk
- Hannover Medical School, Hannover, Deutschland
| | - J. Salman
- Hannover Medical School, Hannover, Deutschland
| | - D. Bobylev
- Hannover Medical School, Hannover, Deutschland
| | - F. Ius
- Hannover Medical School, Hannover, Deutschland
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15
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Oripov F, Ramm R, Falk C, Goecke T, Ebken J, Jashari R, Böthig D, Horke A, Avsar M, Bobylev D, Haverich A, Hilfiker A, Sarikouch S. Serial assessment of early antibody binding to decellularized valved allografts. Front Cardiovasc Med 2022; 9:895943. [PMID: 36017105 PMCID: PMC9395941 DOI: 10.3389/fcvm.2022.895943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesDecellularized homograft valves (DHV) appear to elicit an immune response despite efficient donor cell removal.Materials and methodsA semiquantitative Dot-Blot analysis for preformed and new recipient antibodies was carried out in 20 patients following DHV implantation on days 0, 1, 7, and 28 using secondary antihuman antibodies. Immune reactions were tested against the implanted DHV as well as against the stored samples of 5 non-implanted decellularized aortic (DAH) and 6 pulmonary homografts (DPH).ResultsIn this study, 20 patients (3 female and 17 male patients) were prospectively included, with a median age of 18 years and an IQR of 12–30 years. Six patients received DPH and 14 received DAH. The amount of antibody binding, averaged for all patients, decreased on post-operative days 1 and 7 compared to pre-operative values; and on day 28, antibody binding reached close to pre-operative levels (16.8 ± 2.5 on day 0, 3.7 ± 1.9 on day 1, 2.3 ± 2.7 on day 7, and 13.2 ± 3.7 on day 28). In comparison with the results in healthy controls, there was a higher amount of antibody binding to DAH than to DPH. The mean number of arbitrary units was 18.4 ± 3.1 in aortic and 12.9 ± 4.5 in pulmonary DHV (p = 0.140). Male patients exhibited higher antibody binding to aortic DHV than female patients (19.5 ± 2.1 vs. 1.6 ± 6.7). The p-value calculation was limited, as only two female patients received DAH. There was no correlation between the amount of overall antibody binding to DHV with respect to donor age (Kruskal–Wallis test p = 0.550). DHV recipients with a sex mismatch to the donor showed significantly less antibody binding (6.5 ± 1.8 vs. 13.7 ± 1.8; p = 0.003). Our main finding was an increase in antibody binding in younger patients receiving decellularized aortic allografts. This increase was higher in patients with early degeneration signs but was not specific to the individual DHV implanted nor previous DHV implantation. Antibody binding toward explanted DHV was significantly increased in implicating antibody-mediated DHV degeneration.ConclusionSerial assessment of tissue-specific antibody binding revealed an increase in some patients within 4 weeks after surgery, who subsequently developed early signs of allograft degeneration. Further studies with larger sample sizes are needed to confirm the prognostic relevance of increased antibody activity in addition to targeted research efforts to identify the molecular agents triggering this type of antibody response.
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Affiliation(s)
- Firdavs Oripov
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hanover, Germany
| | - Robert Ramm
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hanover, Germany
| | - Christine Falk
- Institute of Transplant Immunology, Hannover Medical School, Hanover, Germany
| | - Tobias Goecke
- Institute of Transplant Immunology, Hannover Medical School, Hanover, Germany
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Johannes Ebken
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hanover, Germany
| | - Ramadan Jashari
- European Homograft Bank, Clinique Saint-Jean, Brussels, Belgium
| | - Dietmar Böthig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Axel Haverich
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hanover, Germany
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Andres Hilfiker
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hanover, Germany
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
- *Correspondence: Samir Sarikouch,
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16
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Franz M, Siemeni T, Aburahma K, Yablonski P, Poyanmehr R, Avsar M, Bobylev D, Sommer W, Boethig D, Greer M, Gottlieb J, Tudorache I, Hoeper MM, Warnecke G, Haverich A, Kuehn C, Ius F, Salman J. Lung transplantation and severe coronary artery disease: results from a single-centre experience. Eur J Cardiothorac Surg 2022; 62:6608696. [PMID: 35703921 DOI: 10.1093/ejcts/ezac348] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The management of severe coronary artery disease at the time of lung transplantation remains a challenge. We analyzed the short- and long-term-outcomes of lung transplant recipients with severe coronary artery disease. METHODS Records of adult patients transplanted at our institution between April 2010 and February 2021 were retrospectively reviewed. Severe coronary artery disease was defined by coronary stenosis ≥70% (main stem ≥50%) at the coronary angiography performed before or at the time of listing. Patient characteristics, perioperative- and long-term-outcomes were compared between patients with and without severe coronary artery disease. RESULTS Among 896 lung-transplanted patients who had undergone a coronary angiography before transplantation, 77 (8.5%) showed severe coronary artery disease, the remaining 819 (91.5%) did not. Patients with severe coronary artery disease were older (p < 0.0001), more often male (p < 0.0001) and were transplanted more often for pulmonary fibrosis (p = 0.0007). The median (interquartile range) follow-up was 46 (20-76) months. At the Cox multivariable analysis severe coronary artery disease was not associated with mortality. Patients with pretransplant percutaneous transluminal coronary angioplasty and patients with coronary artery bypass graft surgery concomitant to transplantation had equivalent survival compared to patients without severe coronary artery disease (p = 0.513, p = 0.556). CONCLUSIONS Severe coronary artery disease was not associated with decreased survival after lung transplantation. Concomitant coronary artery bypass graft surgery and pretransplant percutaneous transluminal coronary angioplasty can be used for revascularization.
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Affiliation(s)
- Maximilian Franz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Pavel Yablonski
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Medical Faculty of St-Petersburg State University, St-Petersburg, Russia
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiac surgery, Heidelberg Medical School, Heidelberg, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac surgery, Heidelberg Medical School, Heidelberg, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
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17
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Bobylev D, Horke A, Boethig D, Hazekamp M, Meyns B, Rega F, Dave H, Schmiady M, Ciubotaru A, Cheptanaru E, Vida V, Padalino M, Tsang V, Jashari R, Laufer G, Andreas M, Andreeva A, Tudorache I, Cebotari S, Haverich A, Sarikouch S. 5-Year results from the prospective European multi-centre study on decellularized homografts for pulmonary valve replacement ESPOIR Trial and ESPOIR Registry data. Eur J Cardiothorac Surg 2022; 62:6568944. [PMID: 35425983 PMCID: PMC9615428 DOI: 10.1093/ejcts/ezac219] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/28/2022] [Accepted: 03/22/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Dmitry Bobylev
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Hazekamp
- Department of Congenital Cardiac Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Bart Meyns
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hitendu Dave
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Martin Schmiady
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Anatol Ciubotaru
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Eduard Cheptanaru
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Azienda Ospedaliera di Padova, University of Padua Medical School, Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Azienda Ospedaliera di Padova, University of Padua Medical School, Padua, Italy
| | - Victor Tsang
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Ramadan Jashari
- European Homograft Bank, Clinique Saint-Jean, Brussel, Belgium
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexandra Andreeva
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Igor Tudorache
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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18
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Franz M, Aburahma K, Yablonski P, Flöthmann K, Bobylev D, Schwerk N, Sommer W, Greer M, Avsar M, Welte T, Falk C, Haverich A, Kühn C, Warnecke G, Salman J, Ius F. Perioperative Desensitization with IgA- and IgM-Enriched Human Immunoglobulins Allows Safe Lung Transplantation in Patients with Preformed Donor Specific Antibodies. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.633] [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: 11/17/2022] Open
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19
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Helms F, Bobylev D, Wilhelmi M, Lau S, Mlinaric M, Petená E, Hassel T, Haverich A, Horke A, Böer U. A Regenerative Cardiac Patch Based on a Pressure-Compacted and Spider Silk Reinforced Fibrin Matrix. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743033] [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: 10/18/2022]
Affiliation(s)
- F. Helms
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development, Hannover, Deutschland
| | - D. Bobylev
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - M. Wilhelmi
- Department of Vascular- and Endovascular Surgery, St. Bernward Hospital, Hildesheim, Deutschland
| | - S. Lau
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development, Hannover, Deutschland
| | - M. Mlinaric
- Institute for Materials Science, University of Hannover, Hannover, Deutschland
| | - E. Petená
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - T. Hassel
- Institute for Materials Science, University of Hannover, Hannover, Deutschland
| | - A. Haverich
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - A. Horke
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - U. Böer
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development, Hannover, Deutschland
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20
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Petená E, Bobylev D, Boetig D, Cvitkovic T, Tsimashok V, Avsar M, Sarikouch S, Bertram H, Beerbaum P, Haverich A, Horke A. Fontan Fenestration: Postoperative Hemodynamic Relief or Additional Trauma and Cyanosis? Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742996] [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: 10/18/2022]
Affiliation(s)
- E. Petená
- Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße, Hanover, Germany, Hannover, Deutschland
| | - D. Bobylev
- Carl-Neuberg-Straße 1, Hannover, Deutschland
| | - D. Boetig
- Hannover Medical School, Hannover, Deutschland
| | - T. Cvitkovic
- MHH, Carl Neuberg Straße 1, Hannover, Deutschland
| | - V. Tsimashok
- Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße, Hanover, Germany, Hannover, Deutschland
| | - M. Avsar
- Herz-, thorax-, transplantations-, gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | | | - H. Bertram
- Carl-Neuberg-Str. 1, Hannover, Deutschland
| | - P. Beerbaum
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - A. Haverich
- Carl-Neuberg-Straße 1, Hannover, Deutschland
| | - A. Horke
- Carl-Neuberg-Str. 1, Hannover, Deutschland
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21
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Boethig D, Avsar M, Bauer U, Beerbaum P, Berger F, Cesnjevar R, Dähnert I, Dittrich S, Ewert P, Haverich A, Hörer J, Kostelka M, Photiadis J, Sandica E, Sarikouch S, Schubert S, Urban A, Westhoff-Bleck M, Bobylev D, Horke A. Lifetime Endocarditis Risk with Congenital Heart Disease and Pulmonary Valve Prosthesis (PVP): Results from the German Registry for Congenital Heart Defects (CHD). Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742863] [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)
| | - M. Avsar
- Cardiac, thoracic, transplantation and vascular surgery, Hannover Medical School, Hanover, Deutschland
| | - U. Bauer
- Nationales Register Angeborene Herzfehler, Berlin, Deutschland
| | - P. Beerbaum
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - F. Berger
- Augustenburger Platz 1, Berlin, Deutschland
| | | | - I. Dähnert
- Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | | | - P. Ewert
- German Heart Centre Munich / Deutsches Herzzentrum München, München, Deutschland
| | - A. Haverich
- Carl-Neuberg-Straße 1, Hannover, Deutschland
| | | | | | | | - E. Sandica
- Herz-, Diabetes-Zentrum, Bad Oeynhausen, Deutschland
| | | | | | - A. Urban
- Nationales Register Angeborene Herzfehler, Berlin, Deutschland
| | | | - D. Bobylev
- Carl-Neuberg-Straße 1, Hannover, Deutschland
| | - A. Horke
- Carl-Neuberg-Str. 1, Hannover, Deutschland
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22
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Flöthmann K, Aburahma K, Franz M, Poyanmehr R, Iablonskii P, Saipbaev A, Greer M, Avsar M, Bobylev D, Schwerk N, Niehaus A, Sommer W, Warnecke G, Haverich A, Kühn C, Salman J, Ius F. Impact of Donor Quality on Recipient Outcomes in Lung Transplantation: 11-Year Single-Center Experience Using the Eurotransplant Lung Donor Score. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742855] [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)
- K. Flöthmann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - K. Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - M. Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - R. Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - P. Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - A. Saipbaev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - M. Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Deutschland
| | - M. Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - D. Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - N. Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Deutschland
| | - A. Niehaus
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - W. Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - G. Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - A. Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - C. Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - J. Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - F. Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
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23
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Aburahma K, Iablonskii P, Saipbaev A, Niehaus A, Avsar M, Bobylev D, Schwerk N, Sommer W, Greer M, Tudorache I, Warnecke G, Haverich A, Kühn C, Salman J, Ius F. Eight-Year Results of an IgA- and IgM-Enriched Human Immunoglobulin-Based Therapy for Possible Subclinical and Clinical Antibody-Mediated Rejection after Lung Transplantation. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742856] [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)
- K. Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - P. Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - A. Saipbaev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - A. Niehaus
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - M. Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - D. Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - N. Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Deutschland
| | - W. Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - M. Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Deutschland
| | - I. Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Deutschland
| | - G. Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - A. Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - C. Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - J. Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - F. Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
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24
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Franz M, Iablonskii P, Flöthmann K, Bobylev D, Saipbaev A, Schwerk N, Sommer W, Greer M, Avsar M, Warnecke G, Haverich A, Kühn C, Salman J, Ius F. Preformed Donor-Specific Antibodies in Lung Transplantation: Eight-Year Experience with Perioperative Desensitization Using IgA- and IgM-Enriched Human Immunoglobulins. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742813] [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)
- M. Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - P. Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - K. Flöthmann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - D. Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - A. Saipbaev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - N. Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Deutschland
| | - W. Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - M. Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Deutschland
| | - M. Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - G. Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - A. Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - C. Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - J. Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - F. Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
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25
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Cvitkovic T, Bobylev D, Horke A, Avsar M, Beerbaum P, Martens A, Böthig D, Petenà E, Gutberlet M, Beyer FH, Wacker F, Cebotari S, Haverich A, Vogel-Claussen J, Sarikouch S, Czerner C. OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 61:1307-1315. [PMID: 35079774 PMCID: PMC9154340 DOI: 10.1093/ejcts/ezac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/29/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tomislav Cvitkovic
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Corresponding author. Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany. Tel: +49-511-532-9829; e-mail: (T. Cvitkovic)
| | - Dmitry Bobylev
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Böthig
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Elena Petenà
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frerk Hinnerk Beyer
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Czerner
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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26
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Cvitkovic T, Petena E, Sarikouch S, Neubert L, Beerbaum P, Horke A, Bobylev D. Idiopathic Aneurysm of the Aortic Arch in an Infant. Thorac Cardiovasc Surg Rep 2022; 11:e54-e57. [PMID: 36134142 PMCID: PMC9484867 DOI: 10.1055/s-0042-1750426] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Congenital aortic aneurysms are rare disorders, usually associated with genetic aortic syndromes. Here, we describe the case of an idiopathic aortic arch aneurysm which had been diagnosed prenatally by fetal echocardiography. The diagnosis was confirmed after birth in the neonatal period and successful surgical resection of the aneurysm was performed at the age of 3 months. The idiopathic etiology of the aneurysm, its localization, and the early surgical resection render this case very unusual.
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Affiliation(s)
- Tomislav Cvitkovic
- Department of Cardiothoracic, Thransplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Elena Petena
- Department of Cardiothoracic, Thransplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Thransplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Lavinia Neubert
- Institution of Pathology, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Thransplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Thransplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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27
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Iablonskii P, Carlens J, Mueller C, Aburahma K, Niehaus A, Boethig D, Franz M, Floethmann K, Sommer W, Optenhoefel J, Tudorache I, Greer M, Koeditz H, Jack T, Hansmann G, Kuehn C, Horke A, Hansen G, Haverich A, Warnecke G, Avsar M, Salman J, Bobylev D, Ius F, Schwerk N. Indications and outcome after lung transplantation in children under 12 years of age: A 16-year single center experience. J Heart Lung Transplant 2021; 41:226-236. [PMID: 34836753 DOI: 10.1016/j.healun.2021.10.012] [Citation(s) in RCA: 9] [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] [Received: 06/24/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Paediatric lung transplantation poses unique management challenges. Experience regarding indications and outcome is scarce, especially in younger children. The primary aim of this study was to investigate outcome after first lung transplantation in children <12 years of age in comparison to adolescents (12-17 years old). METHODS Records of patients <18 years who underwent first lung transplantation between 01/2005 and 01/2021 were retrospectively reviewed, and compared between children <12 years old and adolescents. Median (IQR) follow-up was 51 (23-91) months. RESULTS Of the 117 patients underwent first lung transplantation at our institution, of whom 42 (35.8%) patients were <12 years and 75 (64.2%) ≥12 years old. Compared to adolescents, children were more often transplanted for interstitial lung disease (33.3% vs 12%, p = 0.005) and precapillary pulmonary hypertension (28.6% vs 12%, p = 0.025), and required more often intraoperative cardiopulmonary bypass (31% vs 14.7%, p = 0.036) and postoperative ECMO support (47.6% vs 13.3%, p < 0.001). Postoperatively, children required longer ventilation times (78 vs 18 hours, p = 0.009) and longer ICU stay (9.5 vs 3 days, p < 0.001) compared to their older counterparts. Primary graft dysfunction grade 3 at 72 hours (9.5% vs 9.3%, p = 0.999), in-hospital mortality (2.4% vs 6.7%, p = 0.418), graft survival (80% vs 62%, p = 0.479) and freedom from chronic lung allograft dysfunction (76% vs 59%, p = 0.41) at 8-year follow-up did not differ between groups. CONCLUSIONS Lung transplantation in children under 12 years is challenging due to underlying medical conditions and operative complexity. Nevertheless, outcomes are comparable to those in older children.
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Affiliation(s)
- Pavel Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Julia Carlens
- Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Carsten Mueller
- Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Adelheid Niehaus
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Maximilian Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Katharina Floethmann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Joerg Optenhoefel
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Harald Koeditz
- Department of Pediatric Cardiology and Critical Care Medicine, Hannover Medical School, Hannover, Germany
| | - Thomas Jack
- Department of Pediatric Cardiology and Critical Care Medicine, Hannover Medical School, Hannover, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care Medicine, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.
| | - Nicolaus Schwerk
- Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
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28
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Bobylev D, Wilhelmi M, Lau S, Klingenberg M, Mlinaric M, Petená E, Helms F, Hassel T, Haverich A, Horke A, Böer U. Pressure-compacted and spider silk-reinforced fibrin demonstrates sufficient biomechanical stability as cardiac patch in vitro. J Biomater Appl 2021; 36:1126-1136. [PMID: 34617818 DOI: 10.1177/08853282211046800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The generation of bio-/hemocompatible cardiovascular patches with sufficient stability and regenerative potential remains an unmet goal. Thus, the aim of this study was the generation and in vitro biomechanical evaluation of a novel cardiovascular patch composed of pressure-compacted fibrin with embedded spider silk cocoons. METHODS Fibrin-based patches were cast in a customized circular mold. One cocoon of Nephila odulis spider silk was embedded per patch during the casting process. After polymerization, the fibrin clot was compacted by 2 kg weight for 30 min resulting in thickness reduction from up to 2 cm to <1 mm. Tensile strength and burst pressure was determined after 0 weeks and 14 weeks of storage. A sewing strength test and a long-term load test were performed using a customized device to exert physiological pulsatile stretching of a silicon surface on which the patch had been sutured. RESULTS Fibrin patches resisted supraphysiological pressures of well over 2000 mmHg. Embedding of spider silk increased tensile force 1.8-fold and tensile strength 1.45-fold (p < .001), resulting in a final strength of 1.07 MPa and increased sewing strength. Storage for 14 weeks decreased tensile strength, but not significantly and suturing properties of the spider silk patches were satisfactory. The long-term load test indicated that the patches were stable for 4 weeks although slight reduction in patch material was observed. CONCLUSION The combination of compacted fibrin matrices and spider silk cocoons may represent a feasible concept to generate stable and biocompatible cardiovascular patches with regenerative potential.
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Affiliation(s)
- Dmitry Bobylev
- Department of Cardiacthoracic, Transplantation and Vascular Surgery, 9177Hannover Medical School, Hannover, Germany
| | - Mathias Wilhelmi
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Hannover, Germany.,Clinic for Vascular and Endovascular Surgery, 14966St. Bernward Hospital, Hildesheim, Germany
| | - Skadi Lau
- Department of Cardiacthoracic, Transplantation and Vascular Surgery, 9177Hannover Medical School, Hannover, Germany.,Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Hannover, Germany
| | - Melanie Klingenberg
- Department of Cardiacthoracic, Transplantation and Vascular Surgery, 9177Hannover Medical School, Hannover, Germany.,Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Hannover, Germany
| | - Markus Mlinaric
- Institute for Material Science, University of Hannover, Garbsen, Germany
| | - Elena Petená
- Department of Cardiacthoracic, Transplantation and Vascular Surgery, 9177Hannover Medical School, Hannover, Germany
| | - Florian Helms
- Department of Cardiacthoracic, Transplantation and Vascular Surgery, 9177Hannover Medical School, Hannover, Germany.,Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Hannover, Germany
| | - Thomas Hassel
- Institute for Material Science, University of Hannover, Garbsen, Germany
| | - Axel Haverich
- Department of Cardiacthoracic, Transplantation and Vascular Surgery, 9177Hannover Medical School, Hannover, Germany.,Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiacthoracic, Transplantation and Vascular Surgery, 9177Hannover Medical School, Hannover, Germany
| | - Ulrike Böer
- Department of Cardiacthoracic, Transplantation and Vascular Surgery, 9177Hannover Medical School, Hannover, Germany.,Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Hannover, Germany
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29
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Avsar M, Petená E, Ius F, Bobylev D, Cvitkovic T, Tsimashok V, Warnecke G, Böthig D, Beerbaum P, Haverich A, Horke A, Köditz H. Pediatric urgent heart transplantation with age or weight mismatched donors: Reducing waiting time by enlarging donor criteria. J Card Surg 2021; 36:4551-4557. [PMID: 34595768 DOI: 10.1111/jocs.16041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite considerable progress in heart transplantation, pediatric waiting list mortality is still high, and often patients do not have enough time to wait. We hypothesized that extending the donor criteria regarding age and weight mismatch does not significantly affect the early follow-up. METHODS We retrospectively analyzed our pediatric heart transplantation patients operated on from 2014 to 2020 for high (>3.0) or low (<0.6) donor-recipient weight ratio (DRWR) or chronological age mismatches (donor organ >5 years older than recipient age). This patient cohort constituted "mismatched heart transplantations" (mHTX). We compared mHTX preoperative status, postoperative course, 1-year survival, and early clinical follow-up to standard pediatric heart transplantations (sHTX). RESULTS We performed 20 pediatric heart transplantations-10 mHTX and 10 sHTX. The minimum DRWR was 0.44, the maximum was 5.60, and the maximum age mismatch was 42.6 years. Median days in the intensive care unit (p = .436) and time-to-first-rejection episode (p = .925) were comparable. Nine patients in each group were alive after 1 year, two patients were operated within 1 year of follow-up. One mHTX patient developed cardiac allograft vasculopathy after 15 months and died 648 days after transplantation (p = .237). All other patients were alive at the end of follow-up and in good clinical conditions (median follow-up for mHTX was 732.5 days, 1149.5 days for sHTX). CONCLUSION Postoperative course and early follow-up after mHTX were comparable to sHTX. In urgent clinical situations, extended donor criteria may be considered an additional option for pediatric heart transplantation.
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Affiliation(s)
- Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Elena Petená
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tomislav Cvitkovic
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Valery Tsimashok
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Dietmar Böthig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Harald Köditz
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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Boethig D, Avsar M, Bauer UMM, Sarikouch S, Beerbaum P, Berger F, Cesnjevar R, Dähnert I, Dittrich S, Ewert P, Haverich A, Hörer J, Kostelka M, Photiadis J, Sandica E, Schubert S, Urban A, Bobylev D, Horke A. Pulmonary valve prostheses: patient's lifetime procedure load and durability. Evaluation of the German National Register for Congenital Heart Defects. Interact Cardiovasc Thorac Surg 2021; 34:297-306. [PMID: 34436589 DOI: 10.1093/icvts/ivab233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We evaluated 4384 procedures performed between 1957 and 2018, collected in the National Register for Congenital Heart Defects, conducted on 997 patients with 1823 pulmonary valve replacements (PVRs), including 226 implanted via catheter [transcatheter valve (TCV)]. Main study targets are as follows: TCV benefit, valve type durability, decade-wise treatment changes and procedure frequencies over the lifetime of a PVR patient. METHODS We studied TCV impact on surgical valve replacement (via Kaplan-Meier); pulmonary valve type-specific performance (Kaplan-Meier and Cox regressions with age group as stratification or ordinary variable); procedure interval changes over the decades (Kaplan-Meier); procedure load, i.e. frequency of any procedure/surgical PVR/interventional or surgical PVR by patient age (multistate analyses). RESULTS TCV performance was equivalent to surgical PVRs and extended durability significantly. Homografts were most durable; Contegras lasted comparably less in older; and Hancock devices lasted less in younger patients. Matrix P-valves showed poorer performance. Age group stratification improves the precision of valve-specific explantation hazard estimations. The current median interval between procedures is 2.6 years; it became significantly shorter in most age groups below 40 years. At 30 years, 80% of patients had undergone ≥3 procedures, 20% ≥3 surgical PVRs and 42% ≥3 surgical or interventional PVRs. CONCLUSIONS TCVs doubled freedom from explantation of conventional valves. Homografts' age group-specific explantation hazard ratio was lowest; Matrix P's hazard ratio was highest. Age-stratified Cox regressions improve the precision of prosthesis durability evaluations. The median time between procedures for PVR patients shortened significantly to 2.6 years. At 30 years, 42% had ≥3 PVRs.
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Affiliation(s)
- Dietmar Boethig
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany.,Department of Pediatric Cardiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany
| | - Murat Avsar
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, German Centre for Cardiovascular Research (DZHK), Berlin, Germany.,German Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Samir Sarikouch
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany
| | - Felix Berger
- Department of Congenital HeartDisease/Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany.,Department of Pediatric Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Ingo Dähnert
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Clinic for Pediatric Cardiology, Leipzig, Germany
| | - Sven Dittrich
- Divisions of Pediatric Cardiology, University of Erlangen, Erlangen, Germany.,Division of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Peter Ewert
- Department of Paediatric Cardiology and Congenital Heart Defects and Congenital Heart Surgery, German Heart Centre of the Technical University of Munich, Munich, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Jürgen Hörer
- Department of Paediatric Cardiology and Congenital Heart Defects and Congenital Heart Surgery, German Heart Centre of the Technical University of Munich, Munich, Germany
| | - Martin Kostelka
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Clinic for Pediatric Cardiology, Leipzig, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Disease, German Heart Institute, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany.,Department of Pediatric Cardiology and Congenital Heart Surgery, German Heart Institute, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany.,Department of Pediatric Heart Surgery, German Heart Institute, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany
| | - Eugen Sandica
- Department of Congenital Heart Disease, Heart and Diabetes Centre, Bad Oeynhausen, Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease, Heart and Diabetes Centre, Bad Oeynhausen, Germany
| | - Aleksandra Urban
- National Register for Congenital Heart Defects, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Dmitry Bobylev
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Alexander Horke
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
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Bobylev D, Avsar M, Sarikouch S, Cvitkovic T, Boethig D, Westhoff-Bleck M, Bertram H, Beerbaum P, Haverich A, Horke A. Valve-sparing aortic root replacement in adult patients with congenital heart disease. Interact Cardiovasc Thorac Surg 2021; 33:959-965. [PMID: 34279037 DOI: 10.1093/icvts/ivab189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 06/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Aortic root dilatation is frequently observed in patients with congenital heart defects (CHD), but has received little attention in terms of developing a best practice approach for treatment. In this study, we analysed our experience with aortic valve-sparing root replacement in patients following previous operations to repair CHD. METHODS In this study, we included 7 patients with a history of previous surgery for CHD who underwent aortic valve-sparing operations. The underlying initial defects were tetralogy of Fallot (n = 3), transposition of great arteries (n = 2), coarctation of the aorta (n = 1), and pulmonary atresia with ventricle septum defect (n = 1). The patients' age ranged from 20 to 40 years (mean age 31 ± 6 years). RESULTS David reimplantation was performed in 6 patients and a Yacoub remodelling procedure was performed in 1 patient. Four patients underwent simultaneous pulmonary valve replacement. The mean interval between the corrective procedure for CHD and the aortic valve-sparing surgery was 26 ± 3 years. There was no operative or late mortality. The patient with transposition of great arteries following an arterial switch operation was re-operated 25 months after the valve-sparing procedure due to severe aortic regurgitation. In all other patients, the aortic valve regurgitation was mild or negligible at the latest follow-up (mean 8.7 years, range 2.1-15.1 years). CONCLUSIONS Valve-sparing aortic root replacement resulted in good aortic valve function during the first decade of observation in 6 of 7 patients. This approach can offer a viable alternative to root replacement with mechanical or biological prostheses in selected patients following CHD repair.
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Affiliation(s)
- Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tomislav Cvitkovic
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Harald Bertram
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Ebken J, Mester N, Smart I, Ramm R, Goecke T, Jashari R, Böthig D, Horke A, Cebotari S, Tudorache I, Avsar M, Bobylev D, Haverich A, Sarikouch S, Hilfiker A. Residual immune response towards decellularized homografts may be highly individual. Eur J Cardiothorac Surg 2021; 59:773-782. [PMID: 33544830 PMCID: PMC8083949 DOI: 10.1093/ejcts/ezaa393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/17/2020] [Accepted: 09/24/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Decellularized homograft valves (DHVs) have shown promising clinical results, particularly in the treatment of congenital heart disease. However, DHV appears to elicit an immune response in a subset of young patients, indicated by early valve degeneration. As the decellularization process is quality controlled for each DHV, we hypothesized that there may be residual immunogenicity within the extracellular matrix of DHV. METHODS A semi-quantitative dot blot analysis was established to screen for preformed recipient antibodies using secondary anti-human antibodies. Fifteen DHV samples (7 aortic, 8 pulmonary) were solubilized and exposed to serum from 20 healthy controls. RESULTS The sera from young controls (n = 10, 18–25 years) showed significantly stronger binding of preformed antibodies than sera from older individuals (n = 10, 48–73 years). The difference between the means of arbitrary units was 15.1 ± 6.5 (P = 0.0315). There was high intraindividual variance in the mean amounts of arbitrary units of antibody binding with some healthy controls showing >10 times higher antibody binding towards 2 different DHV. The amount of preformed antibodies bound to DHVs was higher in aortic than in pulmonary DHVs. The mean number of antibody binding (in arbitrary units) was 17.2 ± 4.5 in aortic and 14.5 ± 4.7 in pulmonary DHV (P = 0.27). The amount of preformed antibodies bound to pulmonary DHVs was statistically significantly higher in the sera of healthy males (n = 10) than in the sera of healthy females (n = 10). The mean number of arbitrary units was 17.2 ± 4.2 in male and 11.7 ± 5.3 in female sera (P = 0.036). Antibody binding to aortic DHV was also higher in males, but not significant (18.8 ± 5.0 vs 15.6 ± 4.0). Blood group (ABO) incompatibility between the serum from controls and DHV showed no impact on antibody binding, and there was no age-related impact among DHV donors. CONCLUSIONS Residual immunogenicity of decellularized homografts appears to exist despite almost complete cell removal. The established dot blot method allows a semi-quantitative assessment of the individual immune response towards extracellular DHV components and potentially the possibility of preoperative homograft matching.
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Affiliation(s)
- Johannes Ebken
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany
| | - Nils Mester
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany
| | - Isabel Smart
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany
| | - Robert Ramm
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany
| | - Tobias Goecke
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany.,Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ramadan Jashari
- European Homograft Bank, Clinique Saint-Jean, Brussels, Belgium
| | - Dietmar Böthig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany.,Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andres Hilfiker
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany
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Horke A, Tudorache I, Laufer G, Andreas M, Pomar JL, Pereda D, Quintana E, Sitges M, Meyns B, Rega F, Hazekamp M, Hübler M, Schmiady M, Pepper J, Rosendahl U, Lichtenberg A, Akhyari P, Jashari R, Boethig D, Bobylev D, Avsar M, Cebotari S, Haverich A, Sarikouch S. Early results from a prospective, single-arm European trial on decellularized allografts for aortic valve replacement: the ARISE study and ARISE Registry data. Eur J Cardiothorac Surg 2021; 58:1045-1053. [PMID: 32386409 PMCID: PMC7577293 DOI: 10.1093/ejcts/ezaa100] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 11/10/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Decellularized aortic homografts (DAH) may provide an additional aortic valve replacement option for young patients due to their potential to overcome the high early failure rate of conventional allogenic and xenogenic aortic valve prostheses. METHODS A prospective, European Union-funded, single-arm, multicentre, safety study was conducted in 8 centres evaluating non-cryopreserved DAH for aortic valve replacement. RESULTS One hundred and forty-four patients (99 male) were prospectively enrolled between October 2015 and October 2018, mean age 33.6 ± 20.8 years; 45% had undergone previous cardiac operations. Mean implanted DAH diameter 22.6 ± 2.4 mm and mean durations for the operation, cardiopulmonary bypass and cross-clamp were 341 ± 140, 174 ± 80 and 126 ± 43 min, respectively. There were 2 early deaths (1 LCA thrombus on day 3 and 1 ventricular arrhythmia 5 h postop) and 1 late death due to endocarditis 4 months postoperatively, resulting in a total mortality of 2.08%. One pacemaker implantation was necessary and 1 DAH was successfully repaired after 6 weeks for early regurgitation following subcoronary implantation. All other DAH were implanted as a free-standing root. After a mean follow-up of 1.54 ± 0.81 years, the primary efficacy end points peak gradient (mean 11.8 ± 7.5 mmHg) and regurgitation (mean 0.42 ± 0.49, grade 0-3) were excellent. At 2.5 years, freedom from explantation/endocarditis/bleeding/stroke was 98.4 ± 1.1%/99.4 ± 0.6%/99.1 ± 0.9%/99.2 ± 0.8%, respectively, with results almost identical to those in an age-matched Ross operation cohort of 212 patients (mean age 34 years) despite DAH patients having undergone >2× more previous procedures. CONCLUSIONS The initial results of the prospective multicentre ARISE trial show DAH to be safe for aortic valve replacement with excellent haemodynamics in the short follow-up period.
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Affiliation(s)
- Alexander Horke
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Jose L Pomar
- Department of Cardiovascular Surgery, Hospital Clinico de Barcelona, Barcelona, Spain.,Department of Cardiology, Hospital Clinico de Barcelona, Barcelona, Spain
| | - Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clinico de Barcelona, Barcelona, Spain.,Department of Cardiology, Hospital Clinico de Barcelona, Barcelona, Spain
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinico de Barcelona, Barcelona, Spain.,Department of Cardiology, Hospital Clinico de Barcelona, Barcelona, Spain
| | - Marta Sitges
- Department of Cardiovascular Surgery, Hospital Clinico de Barcelona, Barcelona, Spain.,Department of Cardiology, Hospital Clinico de Barcelona, Barcelona, Spain
| | - Bart Meyns
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mark Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Michael Hübler
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Martin Schmiady
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - John Pepper
- Department of Cardiovascular Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - U Rosendahl
- Department of Cardiovascular Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Artur Lichtenberg
- Department for Cardiovascular Surgery, Heinrich-Heine University, Düsseldorf, Germany
| | - Payam Akhyari
- Department for Cardiovascular Surgery, Heinrich-Heine University, Düsseldorf, Germany
| | - Ramadan Jashari
- European Homograft Bank, Clinique Saint-Jean, Brussels, Belgium
| | - Dietmar Boethig
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Horke A, Bobylev D, Avsar M, Meyns B, Rega F, Hazekamp M, Huebler M, Schmiady M, Tzanavaros I, Cesnjevar R, Ciubotaru A, Laufer G, Zimpfer D, Jashari R, Boethig D, Cebotari S, Beerbaum P, Tudorache I, Haverich A, Sarikouch S. Paediatric aortic valve replacement using decellularized allografts. Eur J Cardiothorac Surg 2021; 58:817-824. [PMID: 32443152 PMCID: PMC7890932 DOI: 10.1093/ejcts/ezaa119] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/09/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Options for paediatric aortic valve replacement (AVR) are limited if valve repair is not feasible. Results of paediatric Ross procedures are inferior to adult Ross results, and mechanical AVR imposes constant anticoagulation with the inherent risks. METHODS The study design was a prospective, multicentre follow-up of all paediatric patients receiving decellularized aortic homografts (DAHs) for AVR in 8 European centres. RESULTS A total of 106 children (77 boys) were operated (mean age 10.1 ± 4.8 years, DAH diameter 20.5 ± 3.8 mm). A total of 60 (57%) had undergone previous surgical interventions: 34 with 1, 15 with 2 and 11 with ≥3. There was one early death in a 12-year-old girl, who underwent her fourth aortic valve operation, due to intracerebral haemorrhage on extracorporeal membrane oxygenation after coronary reimplantation problems following 3-sinus reconstruction 1 year earlier. One 2-year-old patient died due to sepsis 2 months postoperatively with no evidence for endocarditis. In addition, a single pacemaker implantation was necessary and a 2.5-year-old girl underwent successful HTx due to chronic myocardial failure despite an intact DAH. After a mean follow-up of 3.30 ± 2.45 years, primary efficacy end points mean peak gradient (18.1 ± 20.9 mmHg) and regurgitation (mean 0.61 ± 0.63, grade 0-3) were very good. Freedom from death/explantation/endocarditis/bleeding/stroke at 5 years was 97.8 ± 1.6/85.0 ± 7.4/100/100/100% respectively. Calculated expected adverse events were lower for DAH compared to cryopreserved homograft patients (mean age 8.9 years), lower than in Ross patients (9.4 years) and in the same range as mechanical AVR (12.8 years). CONCLUSIONS Even though the overall number of paediatric DAH patients and the follow-up time span are still limited, our data suggest that DAHs may present a promising additional option for paediatric AVR.
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Affiliation(s)
- Alexander Horke
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bart Meyns
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mark Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Michael Huebler
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Martin Schmiady
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | | | - Robert Cesnjevar
- Division of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Anatol Ciubotaru
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Ramadan Jashari
- European Homograft Bank, Clinique Saint-Jean, Brussels, Belgium
| | - Dietmar Boethig
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Ius F, Salman J, Müller C, Carlens J, Aburahma K, Franz M, Niehaus A, Tudorache I, Sommer W, Greer M, Horke A, Kühn C, Haverich A, Avsar M, Bobylev D, Warnecke G, Schwerk N. Fifteen-Year Single Center Experience with Lung Transplantation in Pediatric Patients Younger Than 12 Years Old. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.996] [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: 10/21/2022] Open
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Flöthmann K, Salman J, Aburahma K, Siemeni T, Franz M, Greer M, Avsar M, Bobylev D, Müller C, Carlens J, Schwerk N, Niehaus A, Sommer W, Tudorache I, Warnecke G, Kühn C, Haverich A, Ius F. Impact of Donor Quality on Recipient Outcomes in Lung Transplantation: 10-year Single-Center Experience Using the Eurotransplant Lung Donor Score. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1903] [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: 11/24/2022] Open
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Salman J, Aburahma K, Siemeni T, Avsar M, Bobylev D, Schwerk N, Sommer W, Greer M, Tudorache I, Falk C, Kühn C, Haverich A, Warnecke G, Ius F. Seven-Year Clinical Results of an IgA-and IgM-Enriched Human Immunoglobulin-Based Therapy for Antibody-Mediated Rejection after Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1077] [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: 11/24/2022] Open
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Franz M, Aburahma K, Siemeni T, Avsar M, Bobylev D, Schwerk N, Mueller C, Sommer W, Boethig D, Greer M, Tudorache I, Warnecke G, Hoeper M, Haverich A, Kuehn C, Salman J, Ius F. Influence of Donor-Recipient Age Mismatch in Young Lung Transplant Recipients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.927] [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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Draeger H, Salman J, Aburahma K, Becker LS, Siemeni T, Boethig D, Sommer W, Avsar M, Bobylev D, Schwerk N, Müller C, Greer M, Gottlieb J, Welte T, Hoeper MM, Hinrichs JB, Tudorache I, Kühn C, Haverich A, Warnecke G, Ius F. Impact of unilateral diaphragm elevation on postoperative outcomes in bilateral lung transplantation - a retrospective single-center study. Transpl Int 2021; 34:474-487. [PMID: 33393142 DOI: 10.1111/tri.13812] [Citation(s) in RCA: 7] [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: 10/25/2020] [Revised: 11/17/2020] [Accepted: 12/27/2020] [Indexed: 12/18/2022]
Abstract
This study evaluated the impact of unilateral diaphragm elevation following bilateral lung transplantation on postoperative course. Patient data for all lung transplantations performed at our institution between 01/2010 and 12/2019 were reviewed. Presence of right or left diaphragm elevation was retrospectively evaluated using serial chest X-rays performed while patients were standing and breathing spontaneously. Right elevation was defined by a > 40 mm difference between right and left diaphragmatic height. Left elevation was present if the left diaphragm was at the same height or higher than the right diaphragm. In total, 1093/1213 (90%) lung transplant recipients were included. Of these, 255 (23%) patients exhibited radiologic evidence of diaphragm elevation (right, 55%; left 45%; permanent, 62%). Postoperative course did not differ between groups. Forced expiratory volume in 1 second, forced vital capacity and total lung capacity were lower at 1-year follow-up in patients with permanent than in patients with transient or absent diaphragmatic elevation (P = 0.038, P < 0.001, P = 0.002, respectively). Graft survival did not differ between these groups (P = 0.597). Radiologic evidence of diaphragm elevation was found in 23% of our lung transplant recipients. While lung function tests were worse in patients with permanent elevation, diaphragm elevation did not have any relevant impact on outcomes.
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Affiliation(s)
- Helge Draeger
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Lena S Becker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Carsten Müller
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Gottlieb
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
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40
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Franz M, Aburahma K, Siemeni T, Avsar M, Bobylev D, Schwerk N, Müller C, Sommer W, Boethig D, Greer M, Tudorache I, Warnecke G, Hoeper M, Haverich A, Salman J, Ius F. Influence of Donor-Recipient Age Mismatch in Young Lung Transplant Recipients. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725593] [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: 10/21/2022]
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41
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Salman J, Aburahma K, Siemeni T, Kühn C, Avsar M, Bobylev D, Franz M, Schwerk N, Niehaus A, Sommer W, Greer M, Tudorache I, Warnecke G, Haverich A, Ius F. Seven-Year Clinical Results of AN IgA- and IgM-Enriched Human Immunoglobulin-Based Therapy for Antibody-Mediated Rejection in Lung Transplantation. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725594] [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: 10/21/2022]
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42
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Cvitkovic T, Horke A, Avsar M, Bobylev D, Beerbaum P, Boethig D, Gutberlet M, Wacker F, Haverich A, Vogel-Claussen J, Sarikouch S, Czerner C. Can Long Decellularized Homografts Restore Normal Blood Flow in the Ascending Aorta? A 4D-Flow CMR Study. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725588] [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: 10/21/2022]
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43
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Franz M, Aburahma K, Siemeni T, Avsar M, Bobylev D, Schwerk N, Müller C, Sommer W, Greer M, Tudorache I, Warnecke G, Hoeper M, Haverich A, Ius F, Salman J. 10-Year Experience with Postoperatively Extended Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation for Patients with Severe Pulmonary Hypertension. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725592] [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: 10/21/2022]
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44
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Ius F, Salman J, Müller C, Carlens J, Aburahma K, Franz M, Niehaus A, Kühn C, Tudorache I, Warnecke G, Horke A, Avsar M, Haverich A, Schwerk N, Bobylev D. Lung Transplantation in Pediatric Patients Younger than 12 Years: 15-Year Single-Center Experience. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725590] [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: 10/21/2022]
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45
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Richter J, Vogel-Claussen J, Bobylev D, Horke A, Westhoff-Bleck M, Bauersachs J, Napp LC. Separate Origin of Four Major Coronary Arteries. Cardiovasc Revasc Med 2020; 25:86-88. [PMID: 33317947 DOI: 10.1016/j.carrev.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jannik Richter
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mechthild Westhoff-Bleck
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - L Christian Napp
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
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46
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Ferraz Cavalcanti PE, Sá MPBO, Lins RFDA, Cavalcanti CV, Lima RDC, Cvitkovic T, Bobylev D, Boethig D, Beerbaum P, Sarikouch S, Haverich A, Horke A. Three-step preoperative sequential planning for pulmonary valve replacement in repaired tetralogy of Fallot using computed tomography. Eur J Cardiothorac Surg 2020; 59:ezaa346. [PMID: 33221863 PMCID: PMC7954262 DOI: 10.1093/ejcts/ezaa346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/25/2020] [Accepted: 07/12/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to compare results between a standard computed tomography (CT)-based strategy, the 'three-step preoperative sequential planning' (3-step PSP), for pulmonary valve replacement in repaired tetralogy of Fallot versus a conventional planning approach. METHODS We carried out a retrospective study with unmatched and matched groups. The 3-step PSP comprised the planning of mediastinal re-entry, cannulation for cardiopulmonary bypass (CPB) and the main procedure, using standard 3-dimensional videos. Operative times (skin incision to CPB, CPB time, end of CPB to skin closure and cross-clamp time) as well as postoperative length of stay and in-hospital mortality were compared. RESULTS Eighty-two patients (49% classical tetralogy of Fallot) underwent an operation (85% with pulmonary homograft) with 1.22% in-hospital mortality. The 3-step PSP (n = 14) and the conventional planning (n = 68) groups were compared. There were no statistically significant differences in the preoperative characteristics. Differences were observed in the total operative time (P = 0.009), skin incision to CPB (P = 0.034) and cross-clamp times (74 ± 33 vs 108 ± 47 min; P = 0.006), favouring the 3-step PSP group. Eight matched pairs were compared showing differences in the total operative time (263 ± 44 vs 360 ± 66 min; P = 0.008), CPB time (123 ± 34 vs 190 ± 43 min; P = 0.008) and postoperative length of stay (P = 0.031), favouring the 3-step PSP group. CONCLUSIONS In patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement, preoperative planning using a standard CT-based strategy, the 3-step PSP, is associated with shorter operative times and shorter postoperative length of stay.
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Affiliation(s)
- Paulo Ernando Ferraz Cavalcanti
- Division of Cardiovascular Surgery of PROCAPE, University of Pernambuco, Pernambuco, Brazil
- Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute, University of Pernambuco, Pernambuco, Brazil
| | - Michel Pompeu Barros Oliveira Sá
- Division of Cardiovascular Surgery of PROCAPE, University of Pernambuco, Pernambuco, Brazil
- Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute, University of Pernambuco, Pernambuco, Brazil
| | | | | | - Ricardo de Carvalho Lima
- Division of Cardiovascular Surgery of PROCAPE, University of Pernambuco, Pernambuco, Brazil
- Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute, University of Pernambuco, Pernambuco, Brazil
| | - Tomislav Cvitkovic
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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47
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Boethig D, Horke A, Hazekamp M, Meyns B, Rega F, Van Puyvelde J, Hübler M, Schmiady M, Ciubotaru A, Stellin G, Padalino M, Tsang V, Jashari R, Bobylev D, Tudorache I, Cebotari S, Haverich A, Sarikouch S. A European study on decellularized homografts for pulmonary valve replacement: initial results from the prospective ESPOIR Trial and ESPOIR Registry data†. Eur J Cardiothorac Surg 2020; 56:503-509. [PMID: 30879050 PMCID: PMC6735763 DOI: 10.1093/ejcts/ezz054] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 10/25/2018] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
- Dietmar Boethig
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Hazekamp
- Department of Congenital Cardiac Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Bart Meyns
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Joeri Van Puyvelde
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Michael Hübler
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Martin Schmiady
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Anatol Ciubotaru
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Azienda Ospedaliera di Padova, University of Padua Medical School, Padova, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Azienda Ospedaliera di Padova, University of Padua Medical School, Padova, Italy
| | - Viktor Tsang
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Ramadan Jashari
- European Homograft Bank, Clinique Saint-Jean, Bruessels, Belgium
| | - Dmitry Bobylev
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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48
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Ius F, Draeger H, Sommer W, Siemeni T, Kühn C, Avsar M, Bobylev D, Schwerk N, Greer M, Haverich A, Tudorache I, Warnecke G. Impact of Diaphragmatic Dysfunction on Postoperative Course after Bilateral Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1014] [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: 10/24/2022] Open
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49
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Ius F, Salman J, Sommer W, Poyanmehr R, Avsar M, Siemeni T, Bobylev D, Schwerk N, Müller C, Haverich A, Kühn C, Warnecke G, Tudorache I. Extracorporeal Membrane Oxygenation during Lung Transplantation and Long-Term Graft Function: Results from a 9-Year Single-Center Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.961] [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: 10/24/2022] Open
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50
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Ius F, Müller C, Sommer W, Verboom M, Hallensleben M, Salman J, Siemeni T, Kühn C, Avsar M, Bobylev D, Poyanmehr R, Erdfelder C, Böthig D, Carlens J, Bayir L, Hansen G, Blasczyk R, Falk C, Tecklenburg A, Haverich A, Tudorache I, Schwerk N, Warnecke G. Six-year experience with treatment of early donor-specific anti-HLA antibodies in pediatric lung transplantation using a human immunoglobulin-based protocol. Pediatr Pulmonol 2020; 55:754-764. [PMID: 31909902 DOI: 10.1002/ppul.24639] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/27/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Experience with the treatment of early donor-specific anti-HLA antibodies (eDSA) after lung transplantation in children is very limited. At our institution, we have treated patients with eDSA since 2013 with successive infusions of intravenous human immunoglobulins (IVIG), combined in some cases with a single dose of Rituximab and plasmapheresis (therapeutic plasma exchange [tPE]) or immunoabsorption. The aim of this study was to present the 6-year results of IVIG-based therapy in pediatric lung recipients. METHODS Records of pediatric (<18 years old) patients transplanted at our institution between 01/2013 and 03/2019 were reviewed. Outcomes were compared between patients with eDSA treated with IVIG (IVIG group) and without eDSA (control group). Median (interquartile range [IQR]) follow-up amounted to 28 (12-52) months. RESULTS During the study period, 66 lung-transplanted pediatric patients were included, of which 27 (41%) formed the IVIG group and 38 (57%) the control group. Among the IVIG patients, 14 (52%) patients showed concomitant graft dysfunction (possible clinical antibody-mediated rejection). The median time to eDSA detection was 24 (14-63) days after transplantation. eDSA were cleared in 25 (96%) of the 26 patients which completed treatment. At 3 years, graft survival (%) was 73 vs 85 (P = .65); freedom (%) from chronic lung allograft rejection (CLAD) was 89 vs 78 (P = .82); and from infection 47 vs 31 (P = .15), in IVIG vs control patients, respectively. CONCLUSIONS After lung transplantation, an IVIG-based treatment for eDSA yielded high eDSA clearance. IVIG and control patients showed similar CLAD-free and graft survival.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Carsten Müller
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Murielle Verboom
- Institute of Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | | | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Caroline Erdfelder
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Böthig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Lale Bayir
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Christine Falk
- German Center for Lung Research (DZL/BREATH), Hannover, Germany.,Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | | | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
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